Qualifying QUESTIONNAIRE Work With Gloria
*Please provide responses to all questions*

*All Information is Private & Confidential*

Once you submit this questionnaire, you will be directed to book your appointment with one of my coaches.
Email address *
First Name *
Your answer
Last Name *
Your answer
What is your primary type of business? *
What is your primary source to get customers? *
What is your current Business Monthly Revenues *
Do you currently have a database (list) of prospects? *
What are you MOST in need of help with right now? *
What do you think is stopping you from having the success you want?* *
Your answer
How committed are you to changing this? *
Will you be financially independent in 3 to 5 years if your business and life continue the way they are now? *
On a scale of 1 - 5, with 5 being HIGH and 1 being LOW, check the number that represents your level of commitment:
I am ready to take action and implement. *
I am able to follow direction and use a system *
I am ready to be held accountable for my actions and my own success. *
I am willing to take risks to be successful. *
I am willing to financially participate in my success. *
I see having a mastermind as critical to my success. *
I am fully aware how valuable mentorship is to me and my business success. *
Write in the box below "I understand my coach’s time is valuable. I agree to show up at the time I to book with my coach."* *
Your answer
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