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Assessment Form

How satisfied are you with your current state in life
Very Satisfied
Somewhat Satisfied
Okay
Somewhat Unsatisfied
Very Unsatisfied
In what area of life would you like to see transformation happen rapidly?
On the scale of 1-10 how much belief do you have in yourself?
1 - Least
2
3
4
5
6
7
8
9
10 - Most
Realistically speaking, how committed do you feel to your inner transformation and growth? There is no right or wrong answer.
I was ready yesterday!!
I feel ready but still testing waters as I go.
I want to take my time and let it happen naturally.
I am uncertain, as I feel overwhelmed as is.
None of these are applicable to me.
Which plan seems to most fit your transformational journey?
A 3-month journey
A 6-month journey
A 12-month journey
Other
Year of Birth
Month
Day
Year
Multi-line address
Today's Date
Month
Day
Year
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