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
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2
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5+
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Job Title / Profession
Yearly Income
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?
Real transformation requires commitment, facing discomfort, and going all the way in. Which describes your current state?
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.
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