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6
Is there a specific issue/challenge that you are wanting to overcome?
- A YES
- B NO
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7
How long has this been a challenge for you?
Rough estimate, please
- A A few MONTHS
- B A few YEARS
- C 3-5 YEARS
- D 5-10 YEARS
- E More than 10 YEARS
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8
How big of a problem is this for you?
Drag the slider to the appropriate level (0 = low, 100 = high)
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9
What is this challenge costing you?
What can't you do?
Is this impacting your work, your health, your relationships, your business, your recreation?
Max. characters 300
Is this impacting your work, your health, your relationships, your business, your recreation?
Max. characters 300
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10
What would life look like if you no longer had this challenge?
How would you feel? What could you do?
Max. characters 300
Max. characters 300
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11
What's your best email address
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2. What is your FIRST NAME?
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Thank you for your interest and for taking the time to let us know a little more about you.
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