Intake Form | Touched By Mya

First name

Last name

Phone

What is success to you? What will make you feel successful?

Address

Birthday

Company

Position

Marital Status

What's Your Monthly Income?

What kind of challenges have you had when trying to be your boss and doubling your income?

Why do you want to Be Your Boss and Double Your Income?

What's your preferred learning style?

What are your specific goal for this call?

Were you referred by someone?

What are you interested in the most, for tips on your journey or learning how you can get mentored along your journey?

Do you prefer one-on-one coaching or group coaching?

How often will you need one-on-one coaching?

Are you committed to your goals?

Is this the beginnng of your journey?

Describe your relationship with achieving your goals?

Describe you/your family blueprint around being your boss and doubling your income- Their thoughts, beliefs, habits, mentality

Where would you like to be in the next 2,5, and 7 months?

Have you ever been in a program, had coaching, webinars, virtual learning or purchased any eBooks?

What is your vision for your life

Do you have social media? Whats your info?

How likely are you to achieve your goals you on a scale from 1-10?

What is going to be the hardest part or biggest obstacles to sucess?

Do you have business? Do you want to sart business? Are you hairstylist? Do you Booth Rent or Have a salon?

I agree to the terms & conditions

Thanks for applying to with us! We'll get back to you soon.