Full Name
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Email
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Phone
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Current Occupation
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Current monthly revenue range
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Under $5K
$5K–$15K
$15K–$30K
$30K+
What feels heaviest for you right now?
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Too many decisions
Lack of clear direction
Constant overthinking
Inconsistent execution
Mental exhaustion
How often do you feel mentally overloaded? (choose one)
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Rarely
Sometimes
Often
Constantly
Which pattern best describes you right now? (choose one)
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I overthink decisions
I start but don’t finish
I keep revising plans
I wait for clarity before acting
I can’t clearly name it but I’m stuck
How long have you been in this state? (choose one)
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Under 3 months
3–6 months
6–12 months
Over a year
If nothing changes in the next 6 months, what happens? (short answer)
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Do you trust your decisions under pressure? (choose one)
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Yes
Sometimes
No
Why is now the time to address this? (short answer)
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Are you prepared to invest $1,500–$70,000 if this is a fit? (choose one)
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Yes
No
Why should I personally consider working with you? (short answer)
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