Discover Your Money Story Session

You can always press Enter⏎ to continue

I am ready to support you in removing the glass ceiling or the guilt that's in your way to creating limitless, exponential wealth. In order to better understand your present condition, please fill out this short questionnaire so I can prepare for our discovery session.

1
1. What's your name?
First Name
Last Name
2
2. What's the BEST email address to reach you?
example@example.com
3
3. What's your phone number?
Area Code
Phone Number
4
4. How did you hear about our Money Therapy/Living Wealthy Program?
5
5. What is your current profession or business?
6
6. Do you have a website? (if so, please list your link)
7
7. What is the biggest challenge you feel you have right now as it relates to money?
Huge
Large
Normal
Small
Ok
Ok
8
8. What is your current monthly revenue (from a business)?
9
9. What is your current monthly personal income?
10
10. Do you have a retirement fund, savings, real estate or other types of investments?
Yes
No
11
11. What is your monthly revenue target?
12
12. What's the NUMBER ONE reason why you haven't yet hit your monthly revenue target?
Huge
Large
Normal
Small
Ok
Ok
13
13. On 1 scale of 1-10 (1 being "not at all" and 10 being "there's a brick wall") do you feel like you have a glass ceiling on your revenue earnings and/or wealth accumulation CURRENTLY?
1
2
3
4
5
6
7
8
9
10
14
14. What negative emotions do you experience on a semi-regular or regular basis (as it relates to money)? (check all that apply)
Anxiousness
Worry
Fear
Guilt
Shame
Anger
15
15. Are you able to financially invest in yourself?
Yes
No
16
16. What have you tried to do in the past to solve this problem?
Huge
Large
Normal
Small
Ok
Ok
17
17. Anything else you want me to know about you?
Huge
Large
Normal
Small
Ok
Ok
18
Tags
[object Object]
Should be Empty:

Question Label

1 of 18See AllGo Back

Save & Continue Later

Your form is saved successfully!

If you want to continue answering your form later, please enter the email address you would like to send the link to:

Please enter a valid email address.

Something went wrong while saving your answers. Please try again.

Email has been sent successfully.

Save your progress

OR

Already have an account? LOGIN

Skip Create an Account

Save your progress

Name

Email Address

Password

I agree to theTerms of ServiceandPrivacy Policy

Your form submission has been saved as a draft.

If you want to continue answering your form later, please enter the email address you would like to send the link to:

Save your progress

OR

Username or email

Password

Forgot Password?

Your form submission has been saved as a draft.

We’ve sent you an email with a link to complete your submission.