First Name
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Last Name
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Your Age
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Your Email Address
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Best phone # to contact you
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State/Province and Country you live in
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Partner's First Name
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Partner's Last Name
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Partner's Age
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How long have you been together and if married how long?
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What is your profession?
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What is your partner's profession?
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Do you have any children at home? If so, please list their age(s) and gender(s).
What has motivated you to reach out to speak with me? And why NOW?
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What are your goals for this call?
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What have you tried that did not work to fix your situation and for how long have you been trying to fix this?
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Why didn't it work in your opinion?
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If you do nothing, what in your life will stay the same? What will change?
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IMPORTANT: If a solution that will solve your issues is presented to you are you able and willing to invest time and financial resources in implementing this solution into your life?
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IMPORTANT: On a scale from 1-10, how ready are you to work on a solution for your relationship right NOW?
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