Apply now to see if you qualify for your <br>"1 Conversation Away" FREE Clarity Session with Polish Peter.

Apply now to see if you qualify for your "1 Conversation Away" FREE Clarity Session with Polish Peter.

Please answer all questions below. Make sure your email/contact info is correct as that's where you'll get access info for the FREE zoom video coaching session with Polish Peter. Please note that filling out the form does not guarantee you a spot for the free session. The free session will be given based on the availability.
Your Name *

First Name Last Name
Your best email address (for contact in regards to the free session) *
Phone Number (if you'd like to be texted with info for the session)
Please enter a valid phone number.
How did you learn about the 1 Conversation Away clarity session? *
Do you have a business? *

Yes No
What kind of business is it? What do you do? (if you don't have a business, do you want to have one? if not, just say: "I don't have a business") *
If you have a business, what is your monthly revenue? *

Less than $5,000 $5,000 - $10,000 $10,000 - $25,000 $25,000 - $100,000 $100,000+ I don't have a business

Session Focus!
What is the #1 thing you want to get out of the session with Polish Peter? *
How badly do you want to have this breakthrough, this change and/or problem solved? *

It's a MUST It's a should It would be nice if it changed but... Ehhh, I could take it or leave it
What do you think is the biggest roadblock stopping you from getting what you want? *
In one word, what do you think is the biggest obstacle keeping you away from reaching your goals? *
If you could wave a magic wand and have a genie grant you any wish, what would you want your life and/or business to look like (say in the next 12 months)? *

Now create your own Jotform - It's free! Create your own Jotform

	Strongly Agree	Agree	Neutral	Disagree	Strongly Disagree
I make decisions FAST
People Look up to me
I accept life as it comes
People say I have a strong personality
I need a lot of details before making a decision
I find it difficult to relax
I enjoy having fun
I tend to do what I am told
I like working by myself
I'm willing to try new things, take a risk
I believe things will go well
I am always willing to help
I generally get my own way
I tend to trust people
If I have to make a decision, I tend to take my time
I am self confident
I like things to be precise and correct
I persevere until I get what I want
I do not treat life too seriously
I am an agreeable type
I often come up with original ideas
I tend to be a cautious person
I am good at convincing people
I am always willing to follow orders
I am a very social sort of person
I don't like arguments
I tend to be very receptive to other people's ideas
I tend to be a forgiving type
I have a lot of energy and vigor
I enjoy chatting with people
I tend to keep my feelings to myself
Accuracy is very important to me
I like to speak my mind
I tend to be an aggressive type
I like to have fun and have a lot of personality
I am good at motivating people
I am careful to say the right thing
I get a lot of satisfaction from helping others
I think about how my decisions might affect others
I like being in the center of things, in crowd
I prefer to get things done now rather than later

Apply now to see if you qualify for your "1 Conversation Away" FREE Clarity Session with Polish Peter.