Rise Unlimited™ Application

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Welcome to the application for our brand new Rise Unlimited™ program which offers as much coaching and support as you need until you are 100% symptom free. Our admissions team will evaluate your application before the scheduled call and subsequently engage with you to assess if we can address your specific needs. If we find that our program aligns with your requirements, we may extend an invitation to join our mentorship. We maintain a stringent selection process, typically accepting only around 20% of applicants due to the substantial time and attention Coach Jordan dedicates to each participant. If we cannot provide assistance, we'll make every effort to direct you to alternative resources that may be of help.
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Please confirm your Full Name* This field is required.
First Name
Last Name
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Phone Number* This field is required.Non US, Please include country code
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Country/Time Zone* This field is required.Please type what country you live in as well as what time zone you are in
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Please confirm your Email Address* This field is required.
example@example.com
Confirm Email
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I acknowledge that the mentorship and strategies that I will learn will likely cause such rapid and sudden results that it may temporarily cause symptom transition anxiety. This is when people suddenly become calm and symptom free after months or years of experiencing symptoms which can temporarily make them feel a bit anxious since they are not used to it. This low-mid level anxiety usually passes within a few weeks once becoming 100% symptom free is the new normal.
I acknowledge
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What primary symptoms are you experiencing?
Depersonalization/Derealization
General Anxiety
Obsessive Thoughts Only
Obsessive Thoughts & Compulsions
Irrational Fears
Panic Attacks
Existential Anxiety
Health Anxiety
Social Anxiety
Emotional Numbness
Concentration/Focus Issues
Memory Issues
Visual Issues
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Are there any other trauma/anxiety symptoms you're experiencing or any medical or neurological issues that you would like our team to know about?
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Do you have funds available to invest in becoming symptom free?* This field is required.
YESNO
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What have you tried so far to get rid of your symptoms and what were the results?* This field is required.
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Ok
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If you are working, what is your current job?* This field is required.
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Ok
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Are you 18 or older?* This field is required.
YESNO
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Are you able to make a four-figure investment in your recovery?* This field is required.
YESNO
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I will 100% be able to make the call on time* This field is required.
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One Final Option To Work W/ MeClick This Link To Join: https://innercircle.coachjordanhardgrave.com/home
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All our programs require a financial investment. For now, check our Youtube channel for tons of free content to help you on your journey!
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Please have a parent/guardian who is 18 or older send us their name, a picture of their ID, as well as writen permission for you to take a call from their email and send it to support@coachjordanhardgrave.com. Once we receive that we will reach back out to setup a call with you. Thanks!
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