Your name?

Your Business? (product/service)

Best Email? (To contact you about the 3 day consultation) *

Phone number?

What's your current average monthly revenue (last 6 months)?

How many hours do you work per week?

Rate your current state (on a scale of 1-10):

Inner peace
Confidence
Time with family
Fulfillment
Trust in yourself

Describe the revenue ceiling you keep hitting? (How does that make you feel?)

What have you invested in trying to solve this? (coaching, courses, etc.)

What did you hope would happen? What actually happened?

What's your biggest frustration with 'mindset work'?

What's your revenue goal for the next 12 months?

What becomes possible at that level that isn't possible now?

If I could show you exactly what's keeping you stuck and give you a proven path forward, what would keep you from saying yes to yourself? (Investment, time, belief, spouse, etc.)