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CONFIDENTIAL INQUIRY

A private, no-obligation conversation begins here.

This survey is designed to create context for thoughtful, confidential conversation. Your responses are reviewed personally and kept strictly private.

Take approximately 3-5 minutes
Reviewed personally, never shared.
No obligation to move forward

BASIC INFORMATION

Full Name *

Phone *

Email *

Organization / Company *

Current Role / Title *

CONTEXT & RESPONSIBILITY

Which best describes your current level of responsibility? *

Founder / Owner

C-Suite Executive

Senior Leader / Partner

Independent Operator / Consultant

Other

(Multiple choice – select one)

How many people are you directly or indirectly responsible for? *

WHY YOU'RE HERE

What prompted you to apply for private executive advisory at this time? *

What feels most unresolved or unclear in your leadership or life right now? *

FOCUS & READINESS

What do you believe is currently competing for your focus or energy? *

What would meaningful clarity look like for you six months from now? *

COMMITMENT & FIT

Are you open to direct, honest conversation that may challenge current assumptions or patterns? *

Yes

Are you seeking long-term clarity and discipline, not quick tactics or motivation? *

Yes

PRACTICAL DETAILS

How did you hear about this advisory work? *

If accepted, are you prepared to invest time, focus, and financial resources into a private advisory relationship? *

Yes

FINAL REFLECTION

Is there anything else that feels important for me to know before we speak? *

Consent & Confidentiality

I understand this inquiry is confidential and does not obligate either party to move forward.

I agree to allow my contact information to be used for other communications and marketing. I understand I can opt out at any time, and my information will not be shared with third parties.

📞. 305.422.9741

✉️. [email protected]

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