First Name *

Last Name *

What is your best email address (e.g. the one you most frequently check) *

What is your mobile number? *

Your occupation or business niche *

Rate your current energy levels: *

Very High - I feel energetic and vibrant throughout the day; rarely experience fatigue.

High - Generally I have good energy levels but occasionally feel tired.

Moderate - My energy levels fluctuate; I have balanced periods of energy and tiredness.

Low - I often feel a lack of energy and experience regular fatigue.

Very Low - I constantly feel drained and struggle with significant fatigue.

What is your big why? In other words, what is the single greatest change in your health you would like to experience that would transform your life, that is not currently being addressed? *

Have you tried any strategies in the past to address these issues? If so, what were they and what were the outcomes? *

How committed are you to achieving your desired health and wellness outcomes? *

Fully Committed - I am completely dedicated and will take all necessary steps to achieve my health and wellness goals.

Highly Committed - I am very serious about my goals and ready to make significant efforts to achieve them.

Moderately Committed - I am committed to my goals but may face challenges in consistently putting in the effort.

Somewhat Committed - While I am interested in achieving my goals I may struggle with motivation or consistency.

Uncertain About Commitment - I am currently unsure about my level of commitment or ability to pursue these health and wellness goals.

How willing are you to invest in your personal health and well-being? (Keep in mind this commitment might require investment of time/energy/$ on your part and my offerings range from $200 per month to $60k per year.) *

Fully Committed - I am highly dedicated to doing whatever is necessary to enhance my health and well-being understanding its impact on my life and work.

Very Willing - I am prepared to significantly invest time effort and resources towards improving my health and well-being.

Moderately Willing - I am open to investing in my health but I need to balance it with other commitments and responsibilities.

Somewhat Hesitant - I am cautious about investing heavily in my health and prefer to take a more conservative approach.

Not Ready at This Time - Currently I am not in a position to invest additional resources in my health and well-being.

Are there any other specific areas you would like to focus on during your Breakthrough Call? *

I agree to terms & conditions provided by the company. By providing my phone number, I agree to receive text messages from the business. Reply STOP to opt out at any time.*

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