Which of the following best describes your current emotional state? *

I feel at peace and balanced

I feel restless, like I’m missing something important

I often feel burnt out or overwhelmed

I struggle with bouts of sadness or unexplainable exhaustion

What is your most significant challenge, the thing that is keeping you awake at night? (for example financial, relationships, mental health) *

Do you feel fulfilled with your current life achievements? *

Yes, I feel fully satisfied.

I’ve achieved a lot, but something still feels incomplete.

I constantly feel like I’m chasing the next thing without true fulfilment.

I feel disconnected from what I truly want.

If you are not fully satisfied, tell us in your own words what you are missing? *

How long have you been working toward getting what you want to feel fully satisfied? *

Less than 6 months

1-2 years

3-6 years

6+ years

Do you struggle with feeling the need to control everything in your life? *

No, I’m comfortable letting go and asking for help

Sometimes, but it doesn’t affect me deeply

Yes, I feel anxious if things are out of my control

I often feel like I’m holding everything together, and it’s exhausting.

How would you describe your relationships (personal, professional, or romantic)? *

Deep and meaningful.

Generally good, but lacking deeper connection.

Superficial or distant—I crave more meaningful relationships.

Strained—I struggle to connect with others. I often feel lonely

Are you open to exploring new perspectives, including spiritual or holistic approaches to growth? *

Yes, I’m excited about it.

I’m curious to learn more

I’m unsure if it will help me

No, I prefer traditional methods

What’s your biggest responsibility right now? *

Managing my career/business.

Balancing family and work

Caring for others (e.g., children, aging parents).

Managing my personal well-being.

How much time can you dedicate to personal growth over the next 3 months? *

I can commit 5+ hours a week.

I can manage 2-3 hours a week.

I’m busy, but I can fit in 1 hour a week

I’m unsure if I can commit time right now.

How often do you feel overwhelmed by your current roles and responsibilities? *

Rarely, I manage things well

Occasionally, but I find ways to cope.

Frequently—I often feel burnt out.

Almost always—it feels like I’m drowning in responsibilities.

Are you ready to make changes in your life to prioritize your well-being? *

Absolutely, I’m ready for transformation.

Yes, but I need guidance on how to start.

I want to, but I’m scared of change.

I’m not sure if I’m ready to prioritize myself.

What is your current professional role or business? *

What is your approximate annual income? *

Below $80,000

$80,000 - $150,000

$150,000 - $250,000

$250,000+

How comfortable are you with investing in personal development or growth programs? *

I regularly invest in personal growth programs.

I’m open to investing if the value aligns with my goals.

I’m cautious about investing in myself.

Have you previously attended retreats, workshops, or coaching programs? *

Yes, multiple times.

Yes, once or twice.

No, but I’m interested.

No, and I’m unsure about it.

How do you typically allocate your budget for self-care and personal growth? *

It’s a high priority—I invest in myself regularly.

I budget for it occasionally when I feel it’s needed.

I rarely spend on personal development.

I prefer to spend on material things rather than personal growth.

What attracted you to the 90 Day Breakthrough system? *

I’m seeking deeper fulfilment and connection

I’m tired of feeling burnt out and want to find balance.

I’m feeling stuck in my personal or professional trajectory.

I want an intelligent, supportive community of like-minded women.

Which of these outcomes are you most excited about? *

Recognizing and owning my self-worth.

Creating self-directed wealth and freedom.

Feeling healthier and more resilient in my everyday life.

Creating or growing a successful business.

If you found a program that could help you achieve these outcomes, would you be ready to invest in yourself? *

Yes, I’m ready to invest in my transformation.

Yes, if I understand the value and results.

I’d like to, but I’m concerned about the cost.

Is there anything holding you back from investing in your growth right now? *

How much personal support do you feel you need to achieve your transformation goals? *

Gold Level—I’m self-motivated but appreciate group support.

Premium Level—I value group sessions but also need individual attention.

Elite—I prefer intensive, one-on-one support tailored to my unique needs.

What level of transformation are you seeking? *

What does this level of transformation look like in your everyday life? *

How much time are you willing to commit to your personal development? *

3 months

6 months

9 months

An intensive, long-term commitment over the next 12 months.

If you could design your ideal personal development experience, what would it include? *

First Name

Last Name *

Email *

Country *

Phone *