Discovery Call Application
Hi! Thanks for showing up today. To ensure that our time is both efficient and productive, please complete this application for a complimentary discovery call with your coach.
Name
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First Name
Last Name
Email
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example@example.com
Phone Number
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(in case of internet connection issues)
Format: (000) 000-0000.
How would you like to be contacted for followup?
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Text
Email
Phone call
I am over 21 years of age.
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Yes
No
Which services are you interested in?
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One-on-one coaching Zoom or phone calls
Digital Course with Voice, Video, or Text messaging support
If applicable, how long has it been since your breakup / relationship from which you would like to move forward? (If you are currently in the relationship you're struggling with, please indicate that here)
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What are some words that describe how you felt during and after your breakup or relationship with which you are struggling? Please list as many as possible.
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What are 1-3 things you are struggling with most right now, or when it comes to getting over your ex or your relationship?
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What have you tried in the past in order to move on from ended relationships? Did it work for you? Please share your experiences here.
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If I could wave a magic wand, what would your #1 desired outcome be? (Where would you like to be in the next 90 days of your healing journey?)
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What investment would you be prepared to make monthly (3 months max) in order to achieve the above desire?
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$50+
$200+
$800+
Coaching can bring you to amazing new heights and realizations in your relationships and life. However in order to accomplish this it also requires a consistent investment of your time and energy to truly reap all of the healing benefits and forward movement. Please describe below why you think you are ready, right now, to do whatever it takes to help yourself become unstuck and make life-changing forward progress.
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How did you hear about my services?
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