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* 1. Please provide me with your contact information.

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* 2. What's Your Age:

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* 3. How Many Kids Do You Have?

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* 4. Are you currently or have you participated in any of Erica's programs/courses:

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* 5. What symptoms do you experience regularly or from time-to-time that you wish you could improve (choose as many that apply to you):

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* 6. What are your top 2-4 interests

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* 7. What's holding you back from reaching your goals:

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* 8. Preference on Podcast Length

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* 9. What would you like to hear on future podcast episodes? Do you have guest requests?

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