To book a strategy call please register on the client portal at https://my.powerdiary.com/clientportal/wildflowersunite.

Once you have registered and booked your call time, complete and submit this form.

Please be available to take the call for up to 15 minutes in a place where you will not be disturbed

Thank you for your time and honesty in answering these pre-strategy call questions. Please make sure you read the answers carefully. Your answers will assist me to help you to the best of my ability and I can assure you that all responses will be kept private and treated with the strictest of confidence.

Name

First Name

Last Name

Phone

(###)

###

####

Occupation

Which apply best to you

Executive

Business Owner

Entrepreneur

Other

Age

What about your current issue/problem(s) bothers you the most?

What are you afraid or concerned of most about having your issue/problem(s)

Are you angry/frustrated/anxious/scared that you have this issue/problem(s)? Why?

What are your top 3 daily frustrations with having this issue/problem(s)

What additional issues are reoccurring because you have this problem?

Is your problem effecting your family, friends, colleagues etc, and how specifically?

Why do you think this problem(s) exists?

What do you truly desire the most if we could resolve this problem(s)?

Who has tried selling you a solution to the problem and why do you think the effort failed?

What is it costing you (both emotionally and financially) to keep your problem(s) over 12 months?

What does your future look like if this problem(s) isn't resolved? Note your feelings as they come up.

On a scale from 1-10 (1 least - 10 most) how important is it for you to finally solve this problem(s)?

How much pain are you in right now, on a scale from 1-10 from having this problem (1 least amount - 10 most amount)?