Lifestyle Survey
1. Please tell us a little bit about yourself
Name:
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Email Address:
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Phone Number:
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2. When is the best time to reach you?
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Morning
Afternoon
Evening
3. What would you like more of in life?
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4. If you could change one thing about your job or current lifestyle what would it be?
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5. How much extra money per month would make a difference for you NOW?
*
6. Which of the following would you (or someone you know) be interested in learning more about?
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Rows
You
Family/Friend
Being Your Own Boss, Owning Your Time
1
2
A secondary stream of income
3
4
Team Building
5
6
Time Freedom
7
8
Tax Advantages of Owning a Small Business
9
10
Replacing Your Current Income
11
12
Career Change / Be Your Own Boss
13
14
Working from Home
15
16
Helping Others Define and Reach Their Goals
17
18
Increased Savings, College Fund, Reduce Debt, etc.
19
20
Coaching, Mentoring, Training
21
22
Other (please specify)
7. Check the Top 5 Positive Characteristics You Possess
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Rows
I am
Coachable
23
Open Minded
24
Team Player
25
Ambitious
26
Well Connected
27
Love Helping Other People
28
Entrepreneurial
29
Out Of The Box Thinker
30
Leader
31
Dependable
32
Self Motivated
33
Goal Oriented
34
Disciplined
35
Friendly/Fun
36
Health Conscious
37
Submit
Should be Empty: