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* 1. How satisfied are you with your current life?

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* 2. If you can change some areas in your life right now, how many areas would you change

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* 3. If you could do anything you wanted, what would you rather be doing?

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* 4. Do you suffer from panic or anxiety attacks?

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* 5. How excited are you to wake up each day to your life and responsibilities?

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* 6. If you could get help and support to create the life you desire, would you invest in it?

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* 7. Name

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* 8. Email

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