Reality Bending Survey

Important: Please fill out this short questionnaire and then schedule your 1-1 time with me on the next page:

Name

Email

If you already have a specific idea of a objective you’d like to experience in the next 40 days, please share with me:

Right now, how motivated are you to make this goal happen?

Right now, how motivated are you to make a big shift in your life? Please elaborate:

Are you available to get started within the next week?

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