Discovery Session Request Form
Please fill out this form and my office will be in touch with you shortly.
Your Name
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First Name
Last Name
Your E-mail Address
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Phone Number
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Area Code
Phone Number
Business Name or Proposed Name
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Website Address
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Put "none" if you do not have a website
Business Description (What do you do or hope to do, and who do you serve?)
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Years in Business
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What are your most challenging business fears and concerns?
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What are your most challenging personal fears and concerns?
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How long have these issues been interfering with your success and happiness and why?
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What have you done to improve these conditions?
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What is your "big why" (your reason) for being in this business?
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What will your life look like if you fail to achieve your goals?
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On a scale from 1 to 10, (1 being not at all and 10 being greatly) how is your business success affecting your personal life?
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1
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10
On a scale of 1-10, (10 being very important) how important is it for you to overcome your challenges and why?
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Where are you located?
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How did you hear about me?
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Please verify that you are human
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Request Your Session
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