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1
Name
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First Name
Last Name
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2
Email
*
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example@example.com
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3
Phone Number
*
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Area Code
Phone Number
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4
What are you currently building (or wanting to build)?
*
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coaching / course / business / career shift / something else
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5
What feels
stuck
right now—and how long have you been in this loop?
*
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(Be real. No Instagram answers.)
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6
What have you already tried to fix this?
*
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courses, certifications, mentors, self-study, nothing yet
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7
On a scale of 1–10, how committed are you to doing the work required to change this?
*
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(If it’s below 8, this may not be the right time.)
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8
Are you willing to invest time, energy, and financial resources if this is the right fit?
*
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Yes / No / I need clarity first
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9
Why is
now
the moment you’re booking this call—and not “someday”?
*
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=
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