Booking Page - Mind Guru Amit

Assessment Form

First Name

Last Name

City

State

Phone

Which of the following describes you best?

In which of the following areas you are struggling most?

Are you working hard for achieving your success and health, yet you are experiencing the patterns of failure, frustration, depression, anxiety, stress, lack of money, and diseases?

Do you feel brain fog, mind clutter, tired and lack of motivation, drive, energy, and purpose?

Do you know, you have more in you and you are capable of achieving it but it’s not happening and you don’t know what is stopping you?

What are the major obstacles stopping you from achieving your Dream life?

Specify your problem/issue in detail

How badly are you committed to living your desired life? (On the scale of 1-10, where 1 = Not committed and 10 = You badly want a solution ASAP)

Have you ever taken professional support to achieve your health, business, income, and relationship goal?

Yes

What is your current monthly income?

If you get an exact blueprint and support system to achieve your Health, Business/Career, Income, and Relationship Goal, how much you will be willing to invest in yourself? (The first session will be FREE!)