Questionaire — Free and Clear Connections

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Let’s work together!

The following are a few questions I would like you to ask yourself and please be honest. This will not work unless you can be totally honest and transparent. If you are a fitting candidate for us to work together, I will be in contact with you within 72 hours.

1. I second guess daily decisions

Yes

No

2. I experience any of the following; sadness, anxiety, substance craving, fear or doubts

Yes

No

3. I have stress or conflict within relationships

Yes

No

4. I continue to repeat the same patterns/behaviors

Yes

No

5. I have poor self-image

Yes

No

6. I am committed to the internal work nesscesary for my total transformation.

Yes

No

7. I believe I am living my true purpose

Yes

No

I have taken prescription drugs in the past year

Yes

No

Name *

First Name

Last Name

Email *

Phone

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Thank you!