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* 1. Please write your full name, email, and phone number below.

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* 2. How did you find me? 

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* 3. What challenges do you want support with at this phase in your life?

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* 4. What is the #1 obstacle that has kept you from overcoming these challenges?

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* 5. What have you tried in the past that didn’t work for you?

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* 6. Why is it important for you to overcome these challenges NOW?

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* 7. If you had a step-by-step plan and all the support you needed, what goal could you achieve in 3 months?

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* 8. Is there anything that stands in the way of you taking empowered action now?

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* 9. Is there anything else you would like me to know?

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