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Free Breakthrough Call Form
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19
Questions
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1
Please confirm your Full Name
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First Name
Last Name
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2
Please confirm your Date of Birth
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Date
Year
Month
Day
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3
Please confirm your Email Address
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Please ensure you use the same as given in the appointment booking
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Confirm Email
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4
And lastly, please confirm your Phone Number
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Please enter a valid phone number.
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5
Were you referred to Karolyn.Live? If so by whom?
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6
I want to improve...
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My own personal development
The relationship between me and my teen
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7
What are the main problems that are showing up in your relationship with your teen?
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8
In an ideal world what would your relationship look like?
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9
What do you feel is your #1 biggest obstacle right now that’s preventing you enjoying a relationship with your teen?
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10
Use the following to describe where you’re at:
Been to counseling & the relationship is going ok, but feel we need a boost
Tried counseling but it didn’t make any difference
Realize that I need to do something but unsure what that looks like
Nothing yet
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11
How long have you been struggling with your relationship with your teen?
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12
How old was your child when you noticed a marked difference in your relationship?
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13
Which of the following best describes you?
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I am excited to do the work necessary to get onto the path of healing my relationship with my Teen. I have access to my own financial resources and can make my own financial decisions.
I am excited to do the work necessary to get onto the path of healing my relationship with my Teen. My spouse/partner and I make financial decisions together. I can make a decision, but I would need to check with them first, or at least let them know.
I am excited to do the work necessary to get onto the path of healing my relationship with my Teen. I don’t have any access to financial resources; my spouse/partner controls everything and I can’t make any kind of an investment without their permission.
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14
Are you currently or have you recently gone through one or many of these life changes:
Relocation across states or borders
Job loss for various reasons
Retirement
Significant birthday milestone
Health warning
Shift in your life relationship: Divorce / Separation / Newly-Wed / Other
Other
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15
In a few words, what would you like to explore during the Breakthrough Call? Please include your main concern.
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16
Which of the following best describes how you feel about your current life status?
I'm excited to embark on a new life journey and am looking for support and accountability as I navigate my way forward.
I feel stuck and need guidance realigning and finding that higher version of myself.
I'm at a crossroad and unclear of which direction would serve me best.
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17
What is your willingness (scale 1-10) to commit the time and invest in transforming your current state of wellbeing?
Please Select
10
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1
Please Select
Please Select
10
9
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1
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18
Right now I…….
Have the financial resources to invest in putting me on a fast track to Realigning my Brilliance.
Have access to the financial resources to invest in putting me on the fast track to Realigning my Brilliance.
Have the financial resources to invest in a 3-month payment plan that will ensure that I Realign my Brilliance.
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19
Is there anything else you would like to share before we embark on our Free Breakthrough Call?
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20
Finally, on a scale of 1 to Marilyn Monroe, how committed are you?
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10
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21
Book your Breakthrough Call:
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