Complimentary 30 Minute Assessment Free 30 Min Money Mindset Assessment Name * Email * What's your skype username? * Country * Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Colombia Comoros Congo Costa Rica Côte d‘Ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Fiji Finland France French Guiana French Polynesia Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guam Guatemala Guinea Guinea-Bissau Guyana Haiti Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati North Korea South Korea Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Mauritania Mauritius Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Zealand Nicaragua Niger Nigeria Norway Northern Mariana Islands Oman Pakistan Palau Palestine Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Puerto Rico Qatar Romania Russia Rwanda Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia and Montenegro Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Sudan Spain Sri Lanka Sudan Suriname Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Togo Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Virgin Islands, British Virgin Islands, U.S. Yemen Zambia Zimbabwe How much money do you desire to make per month in your coaching business? * Between $1,000-$2,000 Between $2,000-$4,000 Between $4,000-$7,500 Between $7,500-$10,000 Between $10,000-$15,000 Between $15,000-$20,000 Between $20,000-$30,000 Between $30,000-$40,000 More than $50,000 How much are you making now per month? (Optional) Between $500-$1,000 Between $1,000-$2,000 Between $2,000-$4,000 Between $4,000-$7,500 Between $7,500-$10,000 Between $10,00-$15,000 Between $15,00-$20,000 More than $20,000 Are you currently working with or scheduled to work with a coach or in a group coaching program? * Yes No Prefer not to say How did you find me? * My Website Facebook Instagram Twitter Friend Referral Google Plus Other Website/Blog Other Have you visited my website? * Yes No How much money are you willing to invest to have private coaching that will support you to clear your blocks and create and build your coaching business? * Less than $1,000 Between $1,000-$5,000 Between $5,000-$7,500 Between $7,500-$10,000 More than $10,000 On a Scale from 1-10 How willing are you to invest financially and emotionally in your transformation? * 1 2 3 4 5 6 7 8 9 10 What Blocks do you desire to eliminate? * Money Blocks Confidence Blocks Visibility Blocks Communication Blocks Business Blocks Why do you want to work with me? * What are the main topics you want to talk about in this 30 min assessment? * Please leave this blank *Complimentary 30 Minute Assessment may be with Jo or a member of the Mission for Balance team.