CryptoConsultz Intake Form

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Welcome

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16Questions

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.
Area Code
Phone Number
4
Please review terms & conditions* This field is required.If you have further questions please contact our CryptoConsultz team before proceeding.
5
What are your goals for your session(s) with your CryptoConsultant?* This field is required.Please be specific.
Huge
Large
Normal
Small
Ok
Ok
6
Please rank your interest in the following CryptoConsultz services offered.
Extremely Interested
Somewhat Interested
Unsure
Not Interested
Learning about cryptocurrecy & blockchain technology.
Learning how to buy and sell cryptocurrency.
Learning about specific coins.
Learning how to keep my investment safe and away from hackers.
Learning about exchanges and how to use them.
Learning how to trade cryptocurrency.
Learning about different types of wallets.
Learning how to create and investment strategy & diversify my portfolio.
Learning about cryptocurrecy & blockchain technology.
Learning how to buy and sell cryptocurrency.
Learning about specific coins.
Learning how to keep my investment safe and away from hackers.
Learning about exchanges and how to use them.
Learning how to trade cryptocurrency.
Learning about different types of wallets.
Learning how to create and investment strategy & diversify my portfolio.
Extremely Interested
Somewhat Interested
Unsure
Not Interested
Extremely Interested
Somewhat Interested
Unsure
Not Interested
Extremely Interested
Somewhat Interested
Unsure
Not Interested
Extremely Interested
Somewhat Interested
Unsure
Not Interested
Extremely Interested
Somewhat Interested
Unsure
Not Interested
Extremely Interested
Somewhat Interested
Unsure
Not Interested
Extremely Interested
Somewhat Interested
Unsure
Not Interested
Extremely Interested
Somewhat Interested
Unsure
Not Interested
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7
How would your rate your technology/computer skills?Compared to the average population.
Technology Challenged
Technology Expert
8
How would you rate your knowledge of cryptocurrency and blockchain technology?Compared to the average population.
Crypto Novice
Crypto Expert
9
Do you currently own any cryptocurrency? (Example: Bitcoin, Ethereum, Ripple, etc.)
YESNO
10
Are there specific cryptocurrencies you'd like to discuss with your consultant?If so, please list them here. If not, leave blank.
11
Do you have previous experience as a finance professional, day trader or similar?
YESNO
12
Are you looking for a personal or business consultation?
Personal
Business
13
Are you a new or returning CryptoConsultz client?
New
Returning
14
How did you hear about CryptoConsultz services?* This field is required.
Friend/Colleague/Family Member
CNN
CryptoConsultz Staff Member
CNBC
Current CryptoConsultz Client
Email
Instagram
Facebook
Twitter
Podcast
Crypto/Blockchain Event
News Article
15
Which consult types are you interested in?Select all that apply.
One on one consultation
Pre-recorded webinars
Business consultation
Live webinars
Ongoing consultations
Other
Just a quick question
16
Would you like to schedule and pay for your consultation now?* This field is required.
YESNO
Should be Empty:

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