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Discovery Consultation Form
10
Questions
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1
Name
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First Name
Last Name
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2
Email
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Use your best email address where we can contact you
example@example.com
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3
Phone Number
Country Code
Area Code
Phone Number
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4
On a scale of 1 to 10, how important is it to help you improve your overall health, energy levels, well-being and success?
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Input a number between 1-10, with one being of lowest importance and 10 be of highest importance
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5
How long have you been struggling with your health, energy levels, well-being and success?
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less than 1 year
1-3 years
3-5 years
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6
Are you willing to invest time & money in order to improve your health, energy levels, well-being and success?
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YES
NO
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7
Are you willing to make changes to your health routine?
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YES!
NO
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8
If you don't do something about your health, energy levels, well-being and success... how will that affect your life in the next year? Or in 3 to 5 years? Mark any that apply...
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Hmm, I don't know. I haven't given it much thought.
My health might get worse and I will feel more old and tired than I really am.
My condition might keep worsening to the point of no return.
I might not be able to have the strength to live my life fully.
My symptoms now might be an indication of worse to my health and body.
Other
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9
If I personally support and show you how to improve your overall health, energy levels, well-being and success ... Would you be willing to commit to a program once a week for the next 1-4 months?
Yes, I can stick for 1 to 4 months.
No, that's too long.
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10
Are you ready to re-invest in yourself?
*
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Yes
No
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