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Breakthrough Consultation Application 
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Email *
What's Your First And Last Name? *
What’s your #1 goal right now for your body, mind, life and performance?

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What challenges are holding you back from achieving that goal?

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How is this affecting your life and business/career right now?
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Have you tried anything in the past to fix this? What happened?

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On a scale of 1-10, how committed are you to making this change now?

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Are you willing and able to invest in yourself to make this transformation happen? (Yes / No)

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What program are you most interested in? *

Phone number & Best time for a call

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