First Name *

Last Name *

Email *

Phone *

SECTION 1: Peak Performance & Energy

1. How would you rate your daily physical energy levels? *

1 – I wake up tired and crash mid-day

2 – I’m okay, but energy is hit or miss

3 – I have decent energy most days3

4 – I’m consistently energized and sharp

5 – I feel unstoppable, physically and mentally

2. How consistently do you follow a strong morning routine?

1 - I don’t have one

2 - I do it once in a while

3 - I do basic stuff most mornings

4 - I have a consistent, intentional routine

5 - My morning routine sets me up to win every damn day

3. How often are you distracted or overwhelmed?

1 - Constantly. My brain never shuts off.

2 - Frequently. It’s hard to stay focused.

3 - Sometimes, depending on the day.

4 - Rarely. I’m mostly in control of my focus.

5 - Almost never. I’m locked in daily.

SECTION 2: Business & Leadership

4. How clearly do you know where your business or career is headed?

1 - I’m honestly not sure

2 - I have some ideas, but not locked in

3 - I have a general direction

4 - I have a clear vision

5 - My vision is crystal clear and driving everything I do

5. How confident are you when making key decisions?

1 - I hesitate and second-guess a lot

2 - I sometimes avoid decisions

3 - I make decisions but question them after

4 - I make solid decisions quickly

5 - I make decisions powerfully and don’t look back

6. How do you show up as a leader for others?

1 - I’m reactive and inconsistent

2 - I lead okay, but sometimes feel like I’m winging it

3 - I try hard but often feel like I’m not making impact

4 - I lead with presence and intention

5 - I lead with power, clarity, and purpose daily

SECTION 3: Habits & Discipline

7. How disciplined are you with the habits that move the needle?

1 - I know what I should do, but rarely do it

2 - I’m hit or miss — depends on how I feel

3 - I do some of the important stuff

4 - I consistently follow key habits

5 - I execute my habits like a machine — they’re locked in

8. How would you rate your time management?

1 - Time controls me

2 - I’m constantly behind

3 - I get things done, but not the right things

4 - I plan my time and stick to it

5 - I own my time and use it strategically

SECTION 4: Mental & Emotional Mastery

10. How strong is your self-talk and internal dialogue?

1 - Brutal. I beat myself up constantly

2 - Negative more than positive

3 - Neutral. Not great, not awful

4 - Mostly positive and empowering

5 - My self-talk is my secret weapon

11. How do you handle adversity or setbacks?

12. Do you feel emotionally grounded and in control?

SECTION 5: Relationships & Personal Life

13. How connected do you feel to your significant other (or closest person)?

1 - We’re distant or disconnected

2 - We try, but it feels strained

3 - We’re good, but not thriving

4 - We have a strong connection

5 - We’re deeply connected and in sync

14. How present are you with your kids/family when you’re with them?

1 - I’m distracted or on my phone a lot

2 - I try to be present but it’s tough

3 - I’m decently engaged

4 - I’m very present when I’m with them

5 - I create meaningful, high-quality time consistently

15. How fulfilled do you feel overall — not just in business, but in life?

1 - Honestly… I feel empty or off

2 - Some days I question it all

3 - I’m doing okay, but I want more

4 - I feel good about where I’m headed

5 - I’m living aligned, driven, and damn proud

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