Last Name *

First Name *

Email *

Phone *

What area of your life are you most focused on improving right now? *

Career and Success

Health and Wellness

Relationships and Connection

Personal Growth and Spirituality

How would you describe your current state of mind? *

Energized and Focused

Stressed and Overwhelmed

Balanced and Content

Curious and Seeking

Which statement resonates with you the most? *

“I want to achieve my goals and dreams.”

“I seek inner peace and well-being.”

“I value deep connections with others.”

“I’m on a journey of self-discovery.”

How do you currently prioritize self-care? *

I make it a daily priority

I try but struggle to find time

It’s important, but I often neglect it

I haven’t thought much about it

Which word best describes your desired state of being? *

Successful

Balanced

Connected

Enlightened

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