Full Name

Phone *

Email *

Age *

Q1. What’s your biggest challenge right now? (Choose one) *

Lack of confidence

No clear direction in life or career

Struggling to communicate or connect with others

Can’t stay consistent or disciplined

Other

Q2. How serious are you about making a change in the next 30 days? (Scale 1–5) *

Not ready

Thinking about it

Somewhat ready

Committed

Fully ready

Q3. Have you ever enrolled (currently or in the past) with any coach for personal development?

Yes

No

Q4. Which statement best describes your investment level for growth?

I’m ready to invest in 1:1 coaching to accelerate change.

I want a structured program that’s practical and affordable.

I’m just exploring and not ready to invest yet.

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