Participant Questionnaire

Dr. Zimmerman’s  “Journey To The Extraordinary”

Participant Questionnaire

This is an on-line form and will need to be completed while you are on the internet.  All questions with an * in front of them are required for this form to process correctly.

The other questions will help Dr. Zimmerman customize the “Journey” so it meets as many of your needs as possible.  Feel free to answer any or all of the questions.  And, of course, all of your information will be kept strictly confidential.

When you have finished filling out the questionnaire, click SUBMIT at the bottom of the page.

Thanks so much.

Click on Journey Assignment Pre-work to get the pre-assignment.  Click here for your Journey Questionnaire (both are also available in the email you were sent).Please print out your pre-work and bring the completed work to the “Live Journey” with you. If you are attending virtually you may e-mail it to  Please call 800-621-7881, if you have any questions or problems.