Breakthrough Session Questionnaire
Please only apply if you have the following:
1. Big Dream and want to find your purpose in life.
2. Open-mind and toward-driven mentality to go after your dream whatever it takes.
3. Strong and consistent spiritual practice and believe in energy, vibration and frequency.
Looking forward to connecting with you♡
Ikumi
* Required
Your Best Email
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Your answer
First Name, Last Name
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Your answer
Your Facebook Profile
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Your answer
Your Phone Number
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Your answer
Are you taking a prescription medication?
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Yes
No
If yes, what kind and what for?
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Your answer
Have you ever been treated for an emotional problem?
Yes
No
Clear selection
If yes, please explain.
Your answer
10. Any Phobias or Fears?
Yes
No
Clear selection
If anything was possible what would you wish for?
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Your answer
What are the biggest change you want to make in your life?
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Your answer
What is the number one thing you want to achieve within the next 3 months?
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Your answer
What is your biggest struggle?
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Your answer
What is most important to you in your life and why?
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Your answer
On a scale of 1 -10 how happy are you with your life right now?
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Not Happy at all :(
1
2
3
4
5
6
7
8
9
10
I'm as Happy as can be :)
What are the things that make you happy?
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Your answer
On a scale of 1-10 how motivated are you in your work/personal life?
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No Motivation :(
1
2
3
4
5
6
7
8
9
10
Super Motivated :)
What motivates you?
Your answer
Have you ever had a business coach or a mentor? Share with me your experience if you had one.
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Your answer
Why are you drawn to Ikumi as a Coach and why now?
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Your answer
What is your annual income?
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Less than $5,000
$5,000+
$10,000+
$25,000+
$50,000+
$100,000+
$250,000+
$500,000+
$1,000,000+
Required
After we review, we'll email you a link to schedule a time for a session if you are qualified :)
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