Mindset Mapping 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 method of communication?

By email

By text

By voice phone call

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* 5. What are the 3 biggest changes you want to make in your life over the next 12 - 36 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 3 things that prevent you from achieving the goals listed in question 6?

1.

2.

3.

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* 8. What is something that you are doing now to move you closer to achieving your goals?

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* 9. How satisfied are you with your life right now?