LASER QUESTIONAIRE

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First Name *

Last Name *

Email *

What is your over-riding goal for the coming year? *

What road blocks held you back from achieving this goal in the past? *

What would it mean to your business and/or personal life to achieve this goal? *

What change are you resisting most? *

If you got in-front of Dr. Trivedi, what would be biggest health barrier to rewire that could change your life? *

Thank you for completing, Confirm below if you'd like to be on stage with Dr. T live during the event. *

Yes, I would love to be on stage with Dr. T!

No, I just want to complete this for myself.