FREE 50-minute Personal Breakthrough Session

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Full Name:

Address:

City, State, Zip:

Email:

Phone:

Male/Female

Birthday

Are you a business owner?

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If yes, briefly tell me about your business:

How long have you been in business?

Website:

Please answer to the following questions to the best of your ability:

In what area of your life are you currently seeking a breakthrough?

What is your desired outcome?

What, if any, other approaches have you tried so far? (Coaching, professional therapy, self-help, energy healing, etc.)

What has worked and what hasn’t?

What is the biggest obstacle that stands in your way at this time?

What else do feel currently holds you back from creating the life, business, and/or lifestyle that you desire?

What are your top 3 goals at this time?

Briefly describe why you are ready for this breakthrough.

What is the best outcome that could come from your breakthrough session?

Anything else I should know to provide you with the best possible outcome?

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