Please Select Call Preference.

Phone CallZoom (Audio)

The following questions are meant to prepare both of us to talk in more depth about your situation. The more information you provide, the more you will get from our hour together.

Please be as detailed as possible. The more specific you are, the better the chance I will be able to help you.

1. What most influenced your decision to complete this consultation form today?

2. Please provide a brief description of the issue and the negative impact it is having on you and your company:

3. What is at risk if we don’t address this issue? How urgent is this situation?

4. What specific outcome are you hoping to achieve from our consultation?

5. To what extent are you willing to work with a methodology you have never heard of before? (My system treats the mind like a biological computer. It is unlike anything you may have seen or read about.)***

Absolutely willingNot SureI am not willing to try a new approach.

6. Are you willing to commit 2 – 4 hours a week (weekdays) for 2 – 3 weeks to work with me to get your life back? Your participation is required. I can’t do it without your full engagement. (We’ll meet by Skype, Zoom or in person.)

Absolutely – YesMaybe – Not SureNot at this time

7. What could derail your focus and carry through?

8. Which statement best describes you? (Please select one only.)

I make quick decisions and follow through on those decisions.I take a long time to decide because I analyze everything in detail.I find it difficult to make quick decisions.
Thank you for requesting a TAKE BACK CONTROL™ consultation. I will be in touch within 24 business hours to schedule our call. If I feel I can be of service to you, I will then invoice you/your company for $275. As mentioned earlier, if we decide to work together, that amount gets rolled into the TAKE BACK CONTROL™ fee.