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* 1. First Name

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* 2. Email (if you'd like to receive the Griever's Guide to Movement: How to use Movement as a Tool for Healing)

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* 3. What has been your biggest challenge in incorporating movement/exercise into your routine while grieving?

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* 4. What would it mean for your life if you solved this problem?

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* 5. What is stopping you from solving this problem?

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* 6. What have you previously done to try and solve this problem? What was missing from those programs or services?

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* 7. How much money have you invested in trying to solve this problem?

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* 8. How does this problem affect other areas of your life (financial, relationships, work, health, spiritual)?

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* 9. How will your life be impacted if you can't solve this problem?

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* 10. What are your top three priorities that you'd like to address in the next 90 days to move forward on solving this problem?

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