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GPS 360 SUCCESS FREE COACHING SESSION APPLICATION
Congratulations on taking this step toward transforming your life!
13
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1
Full Name
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First Name
Last Name
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2
Phone
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Area Code
Phone Number
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3
E-mail
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4
What days work best for you?
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Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
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5
What area(s) do you want to work on with Dr. Linda? Choose all that apply.
*
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Relationships
Feelings of Rejection
Feeling Inadequate
Comparing myself to others
Feelings of rejection
Second-guessing myself
Trying to live up to someone else's expectations
Feeling worthless and inadequate
Other
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6
I am ready to take actions to get-results.
YES
NO
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7
I am open-minded and ready to make improvements in my life.
YES
NO
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8
I am open to constructive criticism.
YES
NO
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9
I am willing and able to invest the time and/or money to improve my life.
YES
NO
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10
What time works best for you?
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Morning
Afternoon
Evening
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11
Have you ever worked with a life coach before?
YES
NO
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12
If your application is approved is there a specific date/time the works best for you? (We will try to schedule the consultation to accommodate your choice.)
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Date
Month
Day
Year
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Hour
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10
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50
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30
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50
Minutes
AM
PM
PM
AM
PM
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13
I would like to be notified about promotional services. Please note that we do not rent or sell your information to any third parties!
*
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Yes
No
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GPS 360 FREE CONSULTATION APPLICATION
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