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* 1. Your Information

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* 2. Please describe your health status right now, including chronic health issues:

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* 3. What is your biggest health concern?

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* 4. What are the three top goals that you would like to achieve by working with Cyndi Lynne

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* 5. What are your biggest obstacles to reaching your goals? What's stopping you or slowing you down?

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* 6. What is it costing you to NOT achieve your goals? Consider your time, money, enjoyment of life, relationships etc.

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* 7. What programs or methods have you tried in the past?

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* 8. What is your deepest, most selfish reason for wanting to achieve your goals?

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* 9. What is your vision of your life when you've achieved your goals?

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* 10. I understand that by filling out this application, I am requesting to be considered for the Optimal Health Formula 12-week private program. At this point in time, I understand I am showing interest only in the program and am under no obligation to join or make payment. Before acceptance into this program, I may be requested to have a 15 minute interview with Cyndi Lynne to ensure a 100% win-win + perfect fit. By entering my name in the space below, I agree to the terms above and submit my application for review:

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