Breakthrough Session Application Form: ALL INFORMATION IS STRICTLY CONFIDENTIAL

Name

Email Address

City and Country

Mobile/Cell Phone

When It Comes To Meditation, What Is The Number One Problem You'd Like To Get Solved?

On a scale of zero to 10, how important to you is it to get these challenges solved? (10 = extremely important)

If You Could Have One Hour With Me To Ask About Meditation, What Question Would You Ask Me?

On a Scale of 1-10 ... 10 being the most stressful, how stressed do you feel?

Do you have any history of mental illness? (Examples: schizophrenia, depression) & if so are you taking any medication and if so for what?

How long have you been trying to Meditate and what's your biggest struggle?

What's ONE thing you must STOP doing in order to take your life to the next level?

What does the term, HIGH PERFORMANCE, mean to you?

Are you a person who follows instructions easily?

To make our time together really valuable, what would you like to talk about in your free session?

On a scale of 1 to Bruce Lee, how awesome are you?

Would you like to subscribe to the Newsletter for more great tips? (Yes or No) 🙂