Breakthrough Application Form

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Please confirm your Full Name* This field is required.

First Name

Last Name

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Please confirm your Email Address* This field is required.Please ensure you use the same as given in the appointment booking.

example@example.com

Confirm Email

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And lastly, please confirm your Phone Number* This field is required.

Please enter a valid phone number.

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What are the main challenges showing up right now because of your grieving process?

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Right now, what’s the number #1 priority for you to tackle which is NOT happening because of being consumed or paralyzed by emotions and feelings?

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What is your biggest obstacle right now to overcoming your grief?

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Briefly tell us about what you’re doing right now to solve this problem (or put an end to your mourning)?

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How long have you been struggling with this problem?

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Right now, I …

Have the financial resources to invest in overcoming grief and maximizing my career and relationships.

I have access to the financial resources to invest in overcoming grief and maximizing my career and relationships.

I don’t have any financial resources at all, and I am going to stay exactly where I am.

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If someone asked me to be open to experience alternative and intuitive healing methods, I would…

Know it’s what any serious influencer, celebrity, or business owner would do to solve this problem

Would be a little intimidated or hesitant, yet with a proven system, I would do it because I am serious about finally putting an end to this debilitating grief

Avoid it all cost because I would rather handle my grief all on my own

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Do you promise to show up for your scheduled appointment ON TIME and DISTRACTION FREE? Please confirm by typing “Yes I will” in the box below.

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