Step 1 of 8

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• What are the biggest blocks that are keeping you from success?*
  • 
    Fear of Failure
  • 
    Fear of Success
  • 
    I am not good enough
  • 
    I am not smart enough
  • 
    Lack of Motivation
  • 
    Not enough time
  • 
    Not enough money
  • 
    Fear of rejection
  • 
    Other

• How long have you suffered with your blocks or limiting beliefs?*
  • 
    1 year
  • 
    1-5 years
  • 
    5-10 years
  • 
    10+ years

• How much have you invested over your lifetime in your personal development? i.e. books, CDs, Seminars, Coaches Etc.*
  • 
    $0-500
  • 
    $500-1000
  • 
    $1000-5000
  • 
    $5000-10000
  • 
    Over $10000

• On a scale from 1 to 10, how committed are you to your own success? Why?*(1 being not very committed, 10 being very committed)
  

  1	2	3	4	5	6	7	8	9	10

• Why did you choose the number above? Explain.

• What are the challenges that you're facing right now that you want to overcome? Please be as detailed as possible.*

• What would change if you could work with a coach and finally remove the inner obstacles that have been holding you back from having the life you want?*

• We've created thousands of success stories with other students over the years, so we know the coaching process works. To continue to create testimonials, we need to make sure that our students are dedicated, open-minded, and teachable. What can you tell us about yourself that makes you a great student?*

• Your Contact Information

• Name*
  
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• Phone*
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• Email*