Pre Informational Assessment

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* 1. Name

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* 2. Email Address

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* 3. Phone Number

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* 4. What is your preferred way of contact?

By email

By phone

No preference

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* 5. What three goals do you want to acheive over the next 6 - 12 months?

Most important

Important

Not as important

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* 6. What would you like to accomplish within the next 90 days?

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* 7. List three roadblocks that prevent you from achieving the goals listed in the prior question?

1.

2.

3.

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* 8. What specific strategies are you currently implementing to progress towards your goals?

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* 9. How satisfied are you with the effectiveness of the strategies you are currently implementing to reach your goals?

Extremely satisfied, comfortable and do not want any additional growth
Satisfied but have thoughts to explore other opportunities for growth
Not satisfied but excited and ready for change
Simply frustrated and dont know what to do

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* 10. Why are you prepared at this moment to "Nail It!" and invest the required time, talent, and resources to achieve your goals?