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Background

Thanks! Please take a few minutes to give me some background that we can talk about.

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* 1. Name

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* 2. Email Address

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* 3. Time Zone or City you live in

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* 4. What is your gender?

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* 5. Age?

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* 6. I have a REAL PRIORITY (goal) I'd like to achieve within the next year

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* 7. Please send me the PDF (P.E.T) Personal Evaluation Toolkit (FREE) as soon as possible.

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* 8. I'm very interested in the 28 Day Breakthrough Course and / or your group coaching!

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* 9. The following questions relate to the 28 Day Breakthrough Course (these are optional)

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* 10. On a Scale of 1 - 10 My Belief that I can achieve my goal is...

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* 11. On a Scale of 1 - 10 My Commitment Level to Achieving this goal is...

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* 12. My Goal is...

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* 13. What has been the greatest highlight of your life so far?

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* 14. What is one of the lowest points of your life (optional- do not have to complete)

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* 15. What is your greatest talent/ability (from a professional/value standpoint)

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* 16. What would a best friend or parent brag about when they were talking about you

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* 17. If I achieve my goal within the next year I will feel...

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* 18. If I do not achieve my goal in the next year I will feel....

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* 19. My desire for coaching is more directed toward

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* 20. I heard about The Habit Factor via

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* 21. List 3 of your best habits

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* 22. My 3 Worst habits are

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* 23. My Annual Income (range)

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* 24. I am able to use my cash/savings and do not have to pay for coaching using debt (credit card)

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* 25. I view coaching for self improvement/goal achievement as a...

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* 26. I am currently using The Habit Factor app (ios or android) and tracking my habits

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* 27. Phone Number or Skype Handle (preferred)

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* 28. Best Time for calls

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