Possibility in Action® Men's Chat Intake
The purpose of this questionnaire is to provide insights to ensure our discovery call is both effective and efficient
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Email *
Name *
Birth Year *
Time Zone *
Which are you interested in? 

NOTE: Upon receipt of this form we will book the appropriate call and I will send you an invoice. Payment is required in advance. 
 *
What is the reason you are seeking a one off call? Be as specific as possible.  *
Have you ever engaged in any personal growth activities *
What types of personal growth activities have you participated in? *
Required
How did you learn about Possibility in Action®  
 *
Required
THE BELOW SECTION IS TO ENSURE EFFICIENCY OF OUR CALL

How much distress or discomfort are you currently experiencing in your life?

 *
Not at all
All the time

How much do you find yourself saying, "I'm just this way"?

 *
Never
All the time

How often do you find yourself focusing on the negative despite a positive outcome?

 *
Never
All the time

To what extent do perceived challenges significantly interfere with your daily functioning?

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Never
All the time

Do you often experience intense emotional distress that affects your ability to cope?

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Never
All the time

How do you view personal growth

 *
It's a FIX
It's a Lifestyle

How motivated are you to focus on the WHY for the future, instead of the WHY of the past?

 *
I want to understand WHY I do things
I want to let go and focus on my future

How much do you believe that your thoughts create your reality?

 *
Completely Disagree
100% Agree

How much do you distrust people or processes? 

 *
Completely Disagree
100% Agree
From 1 - 10 (10 being totally satisfied) - how you would rate your life satisfaction? *
A copy of your responses will be emailed to the address you provided.
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