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* 1. Which statements might you believe about yourself?

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* 2. Which statements do you believe about your life at present?

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* 3. Which statements do you believe about social situations where you don't know most people? (e.g. a house birthday party).

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* 4. Which statements resonate with you about men and dating?

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* 5. Which statements do you believe about your future relationship?

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* 6. I am currently:

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* 7. Do you have children?

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* 8. Is there anything else you would like to specifically mention before our coaching call?

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* 9. What is your name? 

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* 10. Please select your current work situation:

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* 11. How old are you?

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* 12. What is your email address?

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* 13. Which country and city do you live in? (e.g. Sydney, Australia)

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