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?

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
Dissatisfied, frustrated and dont know what to do