First Name
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Last Name
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Email
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Phone
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Relationship Status
Relationship Status
Single
Married
Separated
Divorced
Widowed
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Do you have kids? If so, how many?
Do you have kids? If so, how many?
No Kids
1
2
3
4
5+
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Job Title / Profession
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Yearly Income
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What challenges are you experiencing in your marriage / relationship or dating life?
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Lets dive deeper - How are these challenges impacting you mentally & emotionally … as well as your confidence?
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How is this impacting your professional life … your mission, your goals, and your finances?
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Have you invested in solving this before? What have you tried? Why did they fall short?
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Real transformation requires commitment, facing discomfort, and going all the way in. Which describes your current state?
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Yes, I am READY to take new and uncomfortable action necessary for big change.
I am not ready to take new and uncomfortable action necessary for big change.
The following describes your readiness and resources to invest in your transformation right now.
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I have access to financial resources and I am ready to invest in my transformation right now.
I do not have access to financial resources to invest in myself right now.
Do you commit to showing up for your scheduled appointment ON TIME & DISTRACTION FREE? This means no driving on the call, and you must be in a private space to speak openly and honestly.
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Yes, I am committed.
No, I can’t make any promises.
SUBMIT