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Email *
First Name *
Last Name *
Location *
What are you top 3 health challenges? *
How would your life be different if your health challenges were resolved in the next year?
 *
What approaches have you tried already that worked for you? Please list.
 *
What approaches have you tried that did NOT work for you? Please list.
 *
What changes do you know you could / should make that you haven’t already made?
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What are the biggest barriers to making the changes you already know you should be making?
 *
On a scale of 1 to 10, how committed are you to making the changes you need to make to achieve your health goals? : 10 (extremely committed)
 *
What is the one change / new behavior you commit to making this week that will move you in the direction of your health goal?
 *
A copy of your responses will be emailed to the address you provided.
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