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* 1. What do you need the most help with?   Check all that apply

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* 2. Would you prefer individual or group coaching?

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* 3. Which day would you prefer group coaching?

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* 4. What is your preferred time for group coaching?

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* 5. How much would you pay for group coaching for 1 hour once a week (4 hours per month)

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* 6. Other thoughts on what you need help with right now?

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* 7. Your Name (optional)

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