First name*

Last name*

Email*

Business name

Industry / type of business

How long have you been in business?

Number of full-time team members (including yourself)

Current annual revenue (Under $250K / $250K–$500K / $500K–$1M / $1M–$2.5M / $2.5M–$5M / $5M+)

Current state of your business (Growing fast / Plateaued / Declining / Stable)

Top challenge 1

Top challenge 2

Top challenge 3

Where is the majority of your time going each week?

Is that where your time should be going? If not, where should it be?

Operational structure rating (1–10)

Which operational areas feel most broken or underdeveloped?

Do you have documented systems or SOPs your team follows?

How much does the business depend on you day-to-day? (1–10)

What would change if you could step into a CEO role rather than an operator role?

Relationship with your business (Energized / Drained / Disconnected / Conflicted)

Belief/story you tell yourself when things aren’t working

Where are you holding back (business or leadership)?

How much do you believe you deserve success? (1–10)

What pattern keeps repeating that’s connected to how you think/show up?

What does the version of you that has solved these problems look like?

Success 12 months from now — in the business

Success 12 months from now — personally

What has stopped you from solving these problems before now?

Which RESET tier are you considering? (4-Week / 8-Week / 12-Week / Not sure)

Commitment level (1–10)

Anything else you want us to know before we speak?

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