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* 1. What is your name?

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* 2. At what email address would you like to be contacted?

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* 3. What is your contact phone number?

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* 4. What's your address?

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* 5. What's your occupation?

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* 6. Date of Birth

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* 7. Gender

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* 8. Marital Status

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* 9. CLARITY
Do you feel you are clear about who you are, your purpose, and  the direction you want to
go in life?

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* 10. ENERGY
Do you consistently have enough mental and physical energy needed to excel, accomplish
your goals, and feel motivated and happy?

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* 11. COURAGE
Do you take action and consistently express who you truly are and what you truly think,
need, and desire with the world?

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* 12. PRODUCTIVITY
Are you consistently focused and effective, and are you good at minimizing distractions
and maintaining priorities?

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* 13. INFLUENCE
Do you feel you have the social influence with your family, friends, and team needed to
accomplish your goals?

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* 14. What do you do for a living and why did you choose that career?

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* 15. What are the top 3 goals you are striving to achieve in your life and your career right now?

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* 16. What major stressors and challenges are you struggling with right now?

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* 17. When you feel like your most successful and happy self, what makes you feel that way?

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* 18. What would you dream life look like if you could wave a wand and make it happen?

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* 19. What has prevented you from having that dream?

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* 20. What goal or dream have you ever given up on or failed at?

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* 21. What 3 big changes would you like to make in your life this year or next year?

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* 22. What are you most proud of or excited about in your life right now?

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* 23. What negative recurring thoughts, fears, or behaviors would you like to overcome in order to feel more psychologically free, confident, and successful?

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* 24. What eating, exercise or general health habits would you like to begin or break in order to feel stronger and more healthy physiologically?

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* 25. What distracts you most from being more productive, and what major projects or missions are you struggling to complete faster or more efficiently?

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* 26. If you were more persuasive or influential, what dream or desire would you ask others to support you in achieving?

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* 27. When do you struggle to be fully present in your day or in any of your relationships?

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* 28. How purposeful do you feel in living each day, and how would you describe your purpose?

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