Congratulations on taking this first step! Committing to this 50-minute breakthrough session could be the most powerful thing you've done for yourself in a long while. I'm looking forward to giving you results in our time together. The purpose of this Worksheet is to give me some context for YOU and what you're dealing with so our time is the most effective it can be.
What are the key issues you are seeking to address by working with Justin?
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| Age | {"type":"text","name":"__generic","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please fill in this item.","placeholder":""}
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| Profession | {"type":"text","name":"__generic","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please fill in this item.","placeholder":""}
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| Employed or Self-Employed? | Please ChooseEmployedSelf-Employed{"type":"select","name":"__generic","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please make a selection for this item.","options":"Please Choose\nEmployed\nSelf-Employed"}
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What would it be like if you had it ALL in this/these area(s)?
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What have you tried so far?
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In what way/ways have these problems prevented you from excelling in your professional life, pro-sport, or general living?
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LIFESTYLE QUESTIONS
What wearable tech do you use or have access to?
Please chooseI don't use wearable techApple Watch 6 or olderApple Watch 7 or olderOura RingWhoopBiostrapOther{"type":"select","name":"__generic7","width":100,"value":"","size":"Normal","validation":"N1","validationMessage":"Please make a selection for this item.","options":"Please choose\nI don't use wearable tech\nApple Watch 6 or older\nApple Watch 7 or older\nOura Ring\nWhoop\nBiostrap\nOther"}
Which data points do you have access to/record?
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Please type below your most recent readings (average) from any of the above data points. Ideally using your average over three months (less if you only have that).
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What time do you typically go to bed and wake up?
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On average how many nights a week do you manage to hit these times?
Please ChooseOnce a weekTwice a weekThree times a weekFour times a weekFive times a weekSix times a weekSeven times a week{"type":"select","name":"__generic","width":100,"value":"","size":"Normal","validation":"N1","validationMessage":"Please make a selection for this item.","options":"Please Choose\nOnce a week\nTwice a week\nThree times a week\nFour times a week\nFive times a week\nSix times a week\nSeven times a week"}
What is your typical consumption of alcohol a week?
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Recreational drugs?
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How many portions of fruit and veg do you consume a day (split up fruits and veg)
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When do you eat your last meal in the evening?
Please Choose4pm5pm6pm7pm8pm9pm10pm11pm12pm{"type":"select","name":"__generic","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please make a selection for this item.","options":"Please Choose\n4pm\n5pm\n6pm\n7pm\n8pm\n9pm\n10pm\n11pm\n12pm"}
When do you eat your first meal the next day?
Please Choose5am6am7am8am9am10am11am12pm{"type":"select","name":"__generic","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please make a selection for this item.","options":"Please Choose\n5am\n6am\n7am\n8am\n9am\n10am\n11am\n12pm"}
Do you snack after last meal or before breakfast? (details)
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Do you suffer from any autoimmune diseases? (details)
{"type":"textarea","name":"__generic18","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please fill in this item.","height":80,"placeholder":""}
Do you suffer from skin rashes, back pain, shoulder pain, arthritis, IBS, leaky gut, gout, erectile dysfunction, or other digestive issues?
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Any other medical issues or medications taken? (details)
{"type":"textarea","name":"__generic20","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please fill in this item.","height":80,"placeholder":""}
What vitamins or supplements do you take on a daily basis?
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Walk me through you weekly physical activity? (including rest days)
{"type":"textarea","name":"__generic22","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please fill in this item.","height":80,"placeholder":""}
Have you ever felt like harming yourself? Have you ever acted on it?
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Who will support you in coaching? Who will benefit from you being coached?
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Are you willing to invest 25 - 30 minutes a day in a routine that will change your life?Please ChooseYesNo{"type":"select","name":"__generic","width":30,"value":"","size":"Normal","validation":"","validationMessage":"Please make a selection for this item.","options":"Please Choose\nYes\nNo"}
How did you hear about YourBottomLine.com or Justin Caffrey?
{"type":"checkbox","name":"__generic26","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please make a selection for this item.","options":"Justin's Youtube\nJustin's Linkedin\nJustin's Instagram\nPodcast interview\nGoogle search\nRecommendation\nMy company is working with YBL or Justin"}
Thanks for taking the time to prepare for our breakthrough session - I'm looking forward to jumpstarting the path toward your goal. Speak soon!