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* 1. What is your name?

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* 2. Have you or are you currently engaging in a counseling, coaching or therapeutic process?  And if so, for how long?

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* 3. Have you ever participated in a multi-day intensive experience i.e. bootcamp, workshop?

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* 4. How well do you generally respond to constructive criticism?

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* 5. How well do you generally respond to being pushed beyond your comfort zone?

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* 6. What area of your life do you believe is most in need of a radical transformation?

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* 7. What single change do you believe would have the greatest impact on improving your life right now?

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* 8. How ready do you feel to quit what's not working in your life?

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* 9. How soon are you hoping to schedule a free consultation?

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* 10. What is your email address?

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