QUESTIONNAIRE Thank you for taking the time to fill out this questionnaire. Once you send it in, we'll see to schedule your free consultation as soon as possible. First Name Last Name Email language English Czech Dutch Finnish French German Hungarian Italian Portuguese Russian Slovak Spanish On a scale of 1 to 10, how would you rate your positivity? 1 2 3 4 5 6 7 8 9 10 What in life would you need a more positive outlook about? Is there something specific that you feel brings you down? If there is one thing about yourself, you could change or improve, what would it be? Please provide a phone number for your personal consultation. What is the best time to reach you? Between 10:00 and 12:00 Between 15:00 and 17:00 After 18:00 What is your preferred method of contact Phonecall Chat via Whatsapp Chat via Signal Other (please specify below) Other contact method: Your personal data is processed by New Era Publications International (NEPI) according to the instructions of the Church of Scientology International (CSI, 6331 Hollywood Boulevard, Los Angeles, CA 90028, USA). We, CSI, will use the data you provided above to get in contact with you in order to provide you with more information. In case you do not want to be informed anymore, you can object to the use of your personal data by NEPI and CSI at any time by contacting us at the address above or at dpo@scientology.net. For further information, we refer you to the applicable Privacy Policy. Send