Self-Reinvention Free Course Survey

Email*

1.First Name*

2.Which of these best describes your current situation?*

My habits aren’t aligned with who I want to be

I can’t stay focused or consistent

My energy or health is limiting me

I feel stuck or directionless

I feel mentally scattered or overwhelmed

3.What is the main outcome you want to create next?*

Build better habits

Eliminate distractions and sharpen focus

Improve energy and physical performance

Get clear on my direction and priorities

Create a structured, intentional lifestyle

4.What makes changing this a priority right now?*

I'm not getting any younger

I can feel myself slipping backward

The consequences are starting to show

Something in my life finally forced a wake-up call

I’ve ignored this long enough

5.How do you prefer to approach personal change?*

Direct coaching with accountability

A structured system I can follow step-by-step

Tools and exercises I can use independently

I’m still figuring out what I need

6.If you found the right solution, how ready are you to invest in yourself?*

I’m ready now

I’m open if the value is clear

I prefer to start small

I’m not ready to invest