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1
Instagram handle
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2
Name
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First Name
Last Name
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3
Email
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example@example.com
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4
Appointment
Pick a day and time you’re available to jump on a 10 minute call with me
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5
Do you ever feel you need change parts of yourself in order for you to feel confident?
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6
Do you ever have a hard time looking at yourself in the mirror?
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7
Have you ever thought you needed to lose weight?
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8
On a scale of 1-5 how do you feel about yourself. (5 being extremely confident and 1 being extremely self conscious)
5 extremely confident
4 very confident
3 kinda confident
2 not confident
1 extremely self conscious
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9
Please explain how you really see yourself. This is the first step to healing on this self love journey so be completely honest
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10
Promo Code:
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