Start the Process. Rewrite the Pattern.

1

Name* This field is required.

First Name

Last Name

2

Email* This field is required.

example@example.com

3

Phone Number* This field is required.

Please enter a valid phone number.

4

How would you describe your current mindset in three words?* This field is required.

5

What are three limiting beliefs you’re currently working to overcome (or wish to)?* This field is required.

6

How do you typically respond to setbacks or failure? Give a specific example.* This field is required.

7

In what ways are you currently self-sabotaging your own progress?* This field is required.

8

If nothing was holding you back, describe the life you would be living 12 months from now.* This field is required.

9

What is your dream career, lifestyle, or role—and what has kept you from pursuing it?* This field is required.

10

How would your ideal daily routine look, from morning to night?* This field is required.

11

Who do you admire (living or dead), and what about their life or mindset do you want to emulate?* This field is required.

12

Describe a moment you overcame emotional pain or adversity. What helped you push through?* This field is required.

13

How do you usually deal with uncomfortable emotions like fear, guilt, or shame?* This field is required.

14

What are your go-to methods for self-care, healing, or self-soothing?* This field is required.

15

Why do you want to join the CEO of Me™ Mindset Mentorship right now? Why not a year ago or later?* This field is required.

16

What would make this program a success for you? Be specific.* This field is required.

18

Are you prepared to invest time, energy, and emotional work intotransforming your inner world? Why or why not?* This field is required.

19

Please verify that you are human* This field is required.