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Thank you for your interest in the U.N.L.E.A.S.H.E.D: The 60-Day 9-Step Accelerated Framework to Becoming Your Best Self! Please complete this intake form to help us understand if this transformational journey aligns with your goals, readiness, and commitment. This information will help us ensure you are set up for success as you embark on this path to becoming your best self.

Are you ready and committed to transform your life? *

Yes

No

First Name *

Email *

Phone *

Last Name *

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What areas of your life are you currently seeking to improve? (Select all that apply)

Current Situation & Goals

Personal growth and self-awareness

Health and wellness

Relationships

Career and professional development

Financial mindset and abundance

Describe in a few sentences why you are interested in the *Unleashed* course and what you hope to achieve through it.

On a scale of 1-10, how committed are you to putting in the work required to achieve your personal and professional goals? (1 = Not very committed, 10 = Fully committed)

1

2

3

4

5

6

7

8

9

10

Describe any past experiences where you successfully invested in personal development. What was the outcome? *

Are you ready to dedicate 1-2 hours per day to work on the program materials, including videos, worksheets, and weekly sessions? *

Yes

No

Maybe

The U.N.L.E.A.S.H.E.D course requires a financial investment in your personal growth. Are you prepared and committed to making this investment in yourself? *

Yes, I am fully prepared and committed.

I am prepared but may need guidance on financing options.

No, I am not ready to make a financial investment at this time.

What is your current salary?

Below $3,000

$3,000 - $5,000

$5,000 - $8,000

$8,000 - $10,000

Above $10,000

Why do you believe investing in yourself through a course like U.N.L.E.A.S.H.E.D will be valuable to you? How do you see it positively impacting your life over the long term?

Do you feel there are specific limiting beliefs or patterns holding you back from reaching your full potential? Please describe.

Are you willing to explore and release these limiting beliefs, even if it means stepping out of your comfort zone?

Yes, I am open and willing.

I am open but may need guidance.

I am unsure about this aspect.

Do you have a support system (e.g., friends, family, or a community) that encourages your growth and personal development?

Yes

No

Somewhat

How do you plan to stay accountable to yourself throughout this journey?

We will be sending you a short video to watch before the call. Its important you watch the training that we will send you BEFORE the call or the call will be cancelled. *

I WILL watch the information video BEFORE getting on the call

I will NOT watch the information video

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