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We are excited to learn how we can assist with creating your best life.

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* 1. Your Name

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* 2. Your Email

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* 3. Your Phone

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* 4. Your Age

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* 5. Your Marital Status

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* 6. Your Occupation

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* 7. Rate Your Physical Health

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* 8. Rate Your Finances

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* 9. Rate Your Career

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* 10. Rate Your Relationships

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* 11. Rate Your Emotions

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* 12. Rate Your Time Management

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* 13. Pertaining to the categories of HEALTH, FINANCES, CAREER, RELATIONSHIPS, and EMOTIONS, pick 3 categories that you want to change and/or improve. In the space below, explain what would have to happen in order to take each of these 3 areas to a level 10 experience.

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* 14. What is the PAY OFF for achieving these goals? How is your new life going to be different? What is the upside or the reward for following through on these goals?

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* 15. What beliefs, fears and/or patterns of behaviors have prevented you from already achieving these goals?

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* 16. What is the COST or the Negative Consequences for not following through? What is your life going to be life if you continue to buy into your excuses, patterns and fears?

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* 17. Why are you a good candidate for our coaching and how do you think you will be able to benefit from a coaching program like this?

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* 18. What type of coaching are you looking for?

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