Q.1
Please provide your full name. *


Q.2
Please provide your email address. *

Q.3
Please provide your phone number, city, and state. (If outside the U.S., please provide your country and Skype name) *

Q.4
How did you hear about Keiko Hsu and Wings for Women? *

Q.5
What type of major transition are you currently going through? *

Q.6
What are your top 2-3 goals you are trying to achieve within the next 1-2 years to improve the quality of your life? *

Q.7
What are the greatest challenges you currently face that are getting in the way of you achieving your goals? *

Q.8
What will be the cost or impact to you if you DON’T address these challenges right now? *

Q.9
On a scale of 1 to 10, how important is it for you to achieve the top goals you described in Question #6? Please give a brief explanation for your answer. *

(1=not important at all, 5=somewhat important, 10=extremely important)

Q.10
In an “ideal world”, describe in a brief paragraph what you want your life to be like. *

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