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11
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1
Name
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First Name
Last Name
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2
Email
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example@example.com
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3
What is your age?
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4
What is your phone number?
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Please enter a valid phone number.
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5
Where are you from? (state and city)
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6
What are the different roles in your life?
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Married
Live-in relationship
Relationship
Home maker
Working
Student
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7
Which of the following areas are concerning you right now?
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Communication gaps between relationships
Infidelity
Codependency
Trust issues
Financial blockages
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8
Specify your problems?
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9
What measures have you taken already in order to sort out your relationship problems? Please specify, if any professional support was taken
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10
How badly on a scale of 1-5 you want to transform yourself to get the desired life
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1
2
3
4
5
I don't want to transform myself
I want to transform myself very badly
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11
If you get scientifically proven methods and time-tested strategies to transform your current life to desired life to achieve freedom from your problem, how much are you willing to invest in yourself?
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Money doesn't matter
15-20 K
10-15 K
5-10 K
No, I cannot invest
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