What is your first and last name?
Whats your instagram or Facebook handle?
What is your age?
Phone Number
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What do you struggle with most? (select all that apply)
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bad habits/lack of routine
confidence/self doubt
Finding a positive outlook/perspective
negative thoughts/overthinking/anxiety
self love/people pleasing/self worth
mindfulness/ emotional intelligence
What other areas are you struggling with?
What changes do you want to make mentally and physically?
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What is the biggest goal you are working on right now?
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What are the 1-3 things holding you back the most right now?
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What is your monthly Income?
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<$1,000
$1,500 - $3,000
$3,000 - $6,000
$6,000 - $10,000
>$10,000
Why is it important you get help now?
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Where do you want to be 6 months from now?
What are you looking to accomplish by the end of this call?
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Are you open to working 1:1 with me?
*
Submit
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