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General Information Form

First Name

Last Name

So I can assist you best, please provide the coaching programs you have taken on personal development, business development, digital marketing, health and wellness and time management.

What's your business?

How long have you been in business?

Business level?

A-Beginner

B-Intermediate

C-Advanced

Marketing level?

A-Beginner

B-Intermediate

C-Advanced

What are your 30-day goals?

What are your 60-day goals?

What are your 90-day goals?

What pattern is stopping you from having the success you want?

Who are the key people in your life and what do they provide for you?

What area of your life is your biggest struggle?

A-Relationships

B-Money

C-Health

D-Fulfillment

How committed are you to changing this?

A-Fully Committed

B-Some What

C-Not Really

Will you be financially independent in 3 to 5 years if your life continues in its current direction?

A-Yes

B-No

On a scale of 1 -4, 4 = HIGH, provide a number that represents your level of commitment for the following statements:

I am ready to take action and implement.

A-1

B-2

C-3

D-4

I am able to follow direction and use a system.

A-1

B-2

C-3

D-4

I am ready to be held accountable and hold others accountable for action.

A-1

B-2

C-3

D-4

I am willing to take risks to be successful.

A-1

B-2

C-3

D-4

My experience with Business.

A-1

B-2

C-3

D-4

I am willing to change self-defeating behaviors and actions that are holding me back.

A-1

B-2

C-3

D-4

I am willing to partner, give & receive help on deals within a team environment.

A-1

B-2

C-3

D-4

I am willing to invest in me to receive training and access tools to accelerate my success.

A-1

B-2

C-3

D-4

I am willing to financially participate in my success.

A-1

B-2

C-3

D-4

I believe having a mastermind team and a support community around me as critical to my success.

A-1

B-2

C-3

D-4

I am open and moldable to be mentored.

A-1

B-2

C-3

D-4

If you are a 3 or below on any of the above questions, be honest and tell us your real feelings of why you are below a 3, and what you plan to do to change it.

Desired net worth?

Current approx. net worth?

Current annual income?

How many hours do you want to work weekly?

How many hours do you work weekly?

How many businesses do you currently own/control?

How much net operating income do you want in the next 12 months?

What is the biggest challenge in moving your business forward?

What would you say have been your greatest accomplishments in your life to date?

Write in the box "I agree to show up at the time I'm about to book with my coach."

If you are human, leave this field blank.

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Disclaimer

ZAGGTIME Lifestyle Design does not guarantee results for the products and services it endorses as individual results will vary and depend on how much effort you put in.