Master Key Questionnaire

Let's create a practical plan for success in all areas of your life! It's time for powerful, practical, permanent change!

Should you meet all the criterion, you will receive an email from Dr. Scott to set up your call.

At the agreed upon time, you will speak to him personally. Your questionnaire information is private and confidential.

First Name*

Last Name*

Your Email*

On a scale of 1-10, 10 being the HIGHEST, How committed are you to take consistent action on your goals and dreams now?*

On a scale of 1-10, 10 being the HIGHEST, how willing are you to financially participate in your success?*

How much are you able to invest in your success in the next year?*

$500 - $1,999

$2,000 - $4,999

$5000 - $14,999

$15,000 - $29,999+

$30,000+

Name your top 2 goals for your life that you are powerfully committed to achieving in the next 3-6 months.*

What pattern and roadblocks are holding you back from having the success you want?*

What is your current income from everything, and income goal 12 months from today.*

Be 100% honest, what do you think is stopping you from realizing your short term and long term goals & dreams? *

What is your biggest challenge? *

Why would you make a great candidate to work with Dr. Scott?*

Easy, Simple, & Powerful.

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(516) 606-3876

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