CONFIDENTIAL BREAKTHROUGH ASSESSMENT

Matt Farnsworth
14 Years Sober | Certified Performance Coach - Relationship and Addiction Specialist

Matt only works with a small number of coaching clients at a time.
Once you complete this form you will be able to book an intro call with Matt.
(Your answers are 100% confidential and help Matt prepare for your call)
Takes about 3–4 minutes to complete.

New Client Questions

Full Name

Phone *

Email *

Your Current Situation

What's the #1 thing you're struggling with right now? (Be specific)

How long has this been going on?

Less than 1 year

1-3 years

3-10 years

10+ years

Have you tried to change these issues before? What happened?

Give a few details

Which of the following best describes your goal for improving your life and relationships?

You May Pick More Than One

I want to walk with complete spiritual integrity

I want my spouse or partner to see me differently

I want to break free from patterns that keep me weak

My Marriage is failing and I need help

I want to defeat sin and lust once and for all

I want to discover and walk in God's calling for my life

I want to develop the discipline and mindset of a warrior

I want to completely overcome addiction and live free

What would change in your life if this problem was completely solved?

Keep it simple

Have you invested in coaching, therapy, or programs before?

Yes Or No?

What's the REAL cost if nothing changes?

Answer below

Be brutally honest - what will your life and legacy look like in 5 years if you stay on your current path? 👉

Rate your commitment level:

On a scale of 1-10, how committed are you to doing whatever it takes to change? (1 = Just curious → 10 = I'll do whatever it takes) 👉

How did you hear about this?

Choose One

Facebook

TikTok

YouTube

Friend referral

Other

30 Day Comeback Challenge

Book

Anything else I should know before our call?

Anything you can think of before we chat?

Final question: Are you ALL IN?

This isn't therapy. This is a blueprint to truly rebuild. Are you ready to do the work and follow through on the Blueprint Matt develops for you?

YES - I am ALL IN

NO - I'm not ready for this level of commitment.

CONFIDENTIAL BREAKTHROUGH ASSESSMENT

Matt Farnsworth14 Years Sober | Certified Performance Coach - Relationship and Addiction Specialist

Matt only works with a small number of coaching clients at a time.Once you complete this form you will be able to book an intro call with Matt.(Your answers are 100% confidential and help Matt prepare for your call)Takes about 3–4 minutes to complete.

New Client Questions

Matt Farnsworth
14 Years Sober | Certified Performance Coach - Relationship and Addiction Specialist

Matt only works with a small number of coaching clients at a time.
Once you complete this form you will be able to book an intro call with Matt.
(Your answers are 100% confidential and help Matt prepare for your call)
Takes about 3–4 minutes to complete.