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Pique Mindset Interest Form
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Last Name, First Name
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Your answer
Email Address
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Your answer
Phone Number
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Your answer
Date of Birth
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YYYY
What Time Zone are you in?
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Your answer
Which most closely describes your gender?
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Man
Woman
Transgender Man
Transgender Woman
Non-Binary
Agender/I don’t identify with any gender
Gender not listed.
Prefer not to state
What brings you to coaching?
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Your answer
Have you ever been coached before?
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Yes
No
If Yes, briefly describe your experience
Your answer
What area of life do you want to focus on?
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Personal & Social
Family
Health
Career & Money
Spiritualiy
How did you hear about Pique Mindset?
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Your answer
When you see the words "performance" and "mindset", what comes to mind?
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Your answer
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