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Surveys
2017
February
H
How Can we serve you
How Can we serve you
0%
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Hello: We'd love to find out the best way to serve your needs. Please start with the survey now by clicking on the
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What keeps you up at night?
Wondering about my life purpose
Wasting time
Getting people to make and keep commitments
Feeling pressure and anxiety
Trying to figure out what to do next
Health challenges
Not making all the money I feel I should
Relationship issues
Procrastinating
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What stops you from 'Being Great" at work, home and personal relationships?
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How have you solved, fixed or gotten help for these challenges?
*
Are you ready, able & committed to make a decision to do something about this?
No
Yes, I think so
I'm certain and willing to work in collaboration and take action on our results
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Do you have a budget to solve this/these problems?
Yes
No
Contact Information
*
First Name
:
*
Last Name
:
Address 1
:
Address 2
:
City
:
State
:
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
District of Columbia
Zip
:
Phone
:
Email Address
:
*
Best time to call?
*
How do you want to be coached?
Phone: One-to-one
Phone: In a Group
E-mail
In Person: One-to-one
In Person: Group
*
Commitment level
[Committed now]
[In 1 month]
[In 3 months]
[In 6 months]
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