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Application for Private Consultation

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Name *

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Email *

Best number and times to reach you *

What currently is your biggest challenge? *

What do you think is causing this challenge? *

How have you tried to overcome this problem? *

What made you interested in talking with me? *

What is the result you would like to see as a result of us working together. Please be detailed and specific. *

What are you willing to do differently to get a different result when working with me? *

Are there any other additional comments or questions you would like to share? *

Are you willing to invest the time, money and energy needed for you to get results? *

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