Complimentary Momentum Coaching Session

Please fill out the survey. Be honest with your response. This information for my eyes only and it will allow me to best serve you for our session. Make sure to also schedule a 15 minute session with me via http://schedule.jvny.com

Thanks,
~Joseph

email: joseph@successcircles.com
phone: (917) 745-5313

Your Name

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How did you find out about this special offer?

Please let us know what site or who referred you.

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What's your primary and preferred email address for communication?

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What's your primary phone number so that I can contact you?

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What is your primary occupation?

example: Writer, Programmer, Business strategist, Internet Marketer, enthusiastic entrepreneur, coach...

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Please indicate which of the following describes your current employment situation?

Working full time for an employer
Entrepreneur, Running my own business
In Career transition searching for a job
Working part time currently
Retired, not employed
Other:

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What area(s) of life do you want to have more support with?

Choose all that apply. We will do our best to partner you accordingly.

Joint Ventures / Strategic Alliances
Business and Revenue Generation
Career Transition
Marketing my business
Automation and streamlining operations
My Personal Effectiveness and Productivity
Accountability via SuccessCircles or PeerMomentum
Other:

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Where are you now? – (What is going on in the various areas of your life, such as personal life, work, finances, etc.?)

Please be as open as possible.

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Where do you want to be and by when? – (What are your dreams and goals?)

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What is holding you back?

What's holding you back from accomplishing these goals? What's getting in the way?

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What gives you the sense of urgency that now is the right time to change?

Please be as open as possible.

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