Help me to help you
This is a little series of questions that helps me help you. Please take a moment and fill out all the sections. The more you share the more easier things will be for myself and my team - Johnny Cassell
First name *
Your answer
Last name *
Your answer
Phone number
Your answer
Email *
Your answer
Job Title
Your answer
Company
Your answer
Address 1 *
Your answer
Address 2
Your answer
City *
Your answer
State *
Your answer
Country *
Your answer
zip code *
Your answer
Birthday
MM
/
DD
/
YYYY
Instagram handle *
Your answer
Facebook handle
Your answer
Youtube handle
Your answer
What are some of your sticking points? *
Required
How long have you been living with these issues?
Your answer
What do you think life would look like if you had these issues fixed?
Your answer
Where would you like to be within your social and dating life 6 month from now?
Your answer
How satisfied are you in your social and dating life?
Disatisfied
Satisfied
How would you like to feel overall in your social and dating life?
Disatisfied
Satisfied
Now that you've rated yourself today, how does the score make you feel? (optional)
Your answer
How would you rate your ability with women in its current state?
Dissatisfied
Satisfied
How would you like to feel about your overall ability with women ?
Dissatisfied
Satisfied
Now that you've rated yourself, how does this score make you feel?
Your answer
How do you rate overall the quality of your past or present intimate relationships?
Dissatisfied
Satisfied
How would you like to feel in your intimate relationships?
Dissatisfied
Satisfied
Now that you've rated yourself, how does that make you feel?
Your answer
Anything else I should know about you?
Your answer
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