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Questionnaire - Healing Journey
Date
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Name
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First
Last
Email
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How did you hear about me?
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If on Facebook, please check all that apply
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Through an ad
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If in a Facebook group, which one?
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What country/state/province do you live in?
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Please tell me about yourself and your family
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What led you to contact me today?
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What are the top 3 challenges (or more) you're experiencing in your life right now?
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What would you love to be living instead?
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Where would you like to be in 3 months? A year? 5 years?
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What is in your way of living this vision?
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One a scale of 1 to 10 (10 being highest,) how committed are you to achieving this vision?
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Is there anything else you'd like me to know?
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Home
Programs
Clean Parenting Program
Quick Start Program
Clean Relationships Program
Sisterhood Group
Clean Parenting YOURSELF Program
Healing Sessions
Continuum Concept
Blog
Contact