Life Balance Starts Here!

First Name

Last Name

Date of Birth

Referred by

Cell Phone

Email Address

City

Region/State/Province

Postal / Zip code

1. What brings you Peace & Happiness?

3. What would you currently like to achieve?

5. Which areas of your life would like to be more intentional about? Required

Health (Physical, Mental & Emotional)

Wealth (Financial, Abundance & Prosperity)

Relationships (Family, Friendships & Community)

7. List any other challenges or obstacles do you experience.

9. What is your current planning method?

2. What are you passionate about?

4. Why is this important for you to achieve?

6. What challenges or obstacles do you need to overcome in your life? Required

8. What inspires and motivates you?

10. What challenges or obstacles experience with planning and implementing?

11. What's your occupation?

12. What's the best way to contact you?

Thanks! We will reach out to schedule your Clarity session.