Exit Breakthrough Call Survey Question Title * 1. What area of your life do you most want a breakthrough in right now? Love or Relationships Health or Wellness Money Career or Purpose Personal Transformation Emotional & Spiritual Wellness Weight Loss Other (please specify) Question Title * 2. Are you experiencing any of the following? Anxiety or depression Financial struggles Divorce or breakup Loneliness, wanting to manifest a partner Loss of career Hormonal imbalance or adrenal fatigue Insomnia Health issues Wanting a new career Childhood trauma, poor parenting or abuse Weight gain Loss, death or grieving Other (please specify) Question Title * 3. What is your age? Under 18 18-24 25-34 35-44 45-54 55-64 65+ Question Title * 4. What is the biggest obstacle(s) you are facing right now? Question Title * 5. If there is one question you could ask me, what would it be? Question Title * 6. Is there anything else you'd like to share about what you want to shift in your life right now? Question Title * 7. What available funds do you have or could you attain to invest in your health and wellness? 0-$2500 $2500-$5000 Not able to invest Question Title * 8. Your contact info and email address so I can send you my scheduler to book your breakthrough session. Thank you for helping me fill out the survey! Name City/Town State/Province Country Email Address Phone Number Done