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Impact Connection
I’d love to learn more about you, your goals, and how we can best connect and collaborate. Please complete this short form before we meet. Created By: Senya Borrelli
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Questions
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Name
First Name
Last Name
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2
Email
example@example.com
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3
Phone Number
Please enter a valid phone number.
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4
Professional Snapshot
Where are you today? Challenged ⟶ Thriving
Overall Business Satisfaction
Vision and Clarity
Self-Leadership
Confidence
Work-Life Balance
Community and Support
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Overall Business Satisfaction
Vision and Clarity
Self-Leadership
Confidence
Work-Life Balance
Community and Support
Momentum
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5
What are your top goals right now?
Select all that apply.
Creating Additional Income
Personal Growth
Leadership Development
Better Health and Wellness
Build Meaningful Relationships
Make a Greater Impact
More Time and Flexibility
Exploring New Opportunities
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6
What's your biggest challenge?
What’s currently holding you back from reaching your goals?
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7
How Can I Best Support You?
What would make our conversation most valuable for you??
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8
Who should I thank for connecting us?
If someone referred you, please share their name. If you’re connecting on your own, simply write “Self.”
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