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First Name

Last Name

Email *

Phone *

How old are you? *

Occupation: *

How did you find out about us? *

Instagram

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Other

What is your current income range? USD *

0 - $50,000

$50,000 - $99,000

$100,000 - $149,000

$150,000 +

What is the main thing you want to improve in your life right now? *

Energy & physical health

Mental focus & productivity

Emotional well-being / stress resilience

Career performance & decision-making

Sleep, recovery, or nervous system regulation

All of the above

Other

What’s preventing you from achieving that till this point? *

Lack of knowledge

Lack of structure or a proven system

I’ve tried things but nothing really stuck

I haven’t prioritized myself consistently

I’ve been distracted or spread too thin

Other

What have you tried?

Fitness programs or nutrition plans

Cold plunges, saunas, or biohacking

Meditation, yoga, or breathwork

Supplements or nootropics

Performance or productivity courses

Other coaching programs

Nothing yet—I’m just getting started

How soon are you looking to get help to solve this? *

As soon as possible

2-4 weeks

1-3 months

3+ months

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