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1. *Please note that all of the information you provide is fully confidential and will never be shared.   (Required.)

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2. Who referred you to Heidi? (Required.)

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3. What is your name? (Required.)

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4. How can we reach you to set up your consultation? (best email & cell #) (Required.)

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5. What inspired you to request a consult with Heidi?  What challenges are you facing? (Required.)

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6. If you could wave a magic wand, what changes would you make in your life right now? (Required.)

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7. In what ways have you previously tried to address these challenges? What were the results? (Required.)

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8. Do you feel that you are ready and willing to address these challenges, invest in yourself (emotionally, time-wise and financially) to create the change you're desiring ? (Required.)

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9. On a scale of 1-10  ("10" being most important), how important is it for you to break free from these challenges and create inner peace, freedom and authentic happiness? (Required.)

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10. Thank you for taking the time to fill out this application.  Please feel free to share below anything else you'd like Heidi to know:

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