* 1. What is your first and last name? I will not share your name or contact info with anyone. I only need it to follow-up with you.

* 2. Email

* 3. Phone

* 4. Do you have a sense of your big vision, your big why, or your future potential if nothing were to stand in your way? Tell me about it.

* 5. If things go ideally for you, where would your business, life or relationships be in 6 months? In a year?

* 6. And if you could have all that, what would it do for you?

* 7. What do you think could be slowing you down, standing in the way, or stopping you, from having that experience?

* 8. What effect do you think these challenges have had on your life?

* 9. What's likely to happen if nothing changes with these challenges in your life?

* 10. On a scale of 1-10, 10 being the highest, how committed are you to do what it takes to move past these challenges, so you can take a leap to the next phase of your life?

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