The Unplugged Excellence Coaching Questionnaire

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This survey contains a series of questions that, if answered truthfully, will tell us whether or not you will benefit from working with us.

Our coaching is tailored to your specific needs. By answering in a thoughtful way, you make it easier for us to help you.

All questions are mandatory. If you skip, you will have to go back to complete them.

We will reach out to you via DM on Twitter within 48 hours to let you know if we can help you or not.

There are 14 quick questions total and should take you no longer than 5-10 minutes.

What is Your Reason for Filling Out This Questionnaire? (Select all that apply) *

I want to be in better shape

I am not attractive to women and want to be

It seems to me that women generally find me interesting, but they still quickly lose attraction.

I want to feel confident in myself and currently don't

I lack discipline and need accountability to help me get my life together

My life feels very unfulfilling and I want create a life that I am excited to live

I want direction, structure and a plan to improve my life

I am struggling with compulsive behaviors like porn or smoking weed and am ready to quit

I want to become a high value man

All of the above

Required

On a scale of 1-5 how happy are you with your life right now?
*

I am not happy at all

I love my life and what I see when I look in the mirror

What do you do for work?
*

Type of employment
*

Part time

Full time

Self employed

Unemployed

What is your motivation behind wanting to work with us? What do you hope to accomplish?
*

Where are you currently, in relation to your goals?
*

What do you think is the biggest thing holding you back right now?
*

How long have you been trying to fix this problem?
*

0-3 months

3-6 months

6-12 months

Over a year

On a scale of 1-10 how serious are you about solving these problems?
*

Our services range from $149-$199. If we decide you are a fit for one of our packages - will you be ready to move forward?
*

Yes

Your name
*

Your country
*

Twitter handle (We will be reaching out to you here)
*

Email (We will email you if we can't reach you on Twitter)
*

Submit

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