BIOENERGETIC ANALYSIS FORM
Complete this form if you would like a chance for Elliott to analyze your bioenergetic Character Structure.  By submitting this form you are giving Elliott Hulse permission to share your case on YouTube, social media or one of his websites, if he so chooses. If you would prefer a PRIVATE ANALYSIS email replies@elliotthulse.com to inquire. 
Email *
Name *
How old are you?  *
What is your birth date?
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Where do you live?
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What kind of work do you do?
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How did you know about Elliott Hulse?
*
How was your parents relationship with each other?
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How was/is your relationship with your parents?
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What is the #1 biggest challenge in your life right now? 
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What else should I know about you?
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VIDEO SUBMISSION - Film yourself showing your full body with clothes on, turning around to face all four directions, pausing in each direction for 5 seconds.  Then back to the camera and answer each of the questions above in your own words (don't just read what you wrote).  Upload your video to YouTube as 'unlisted' and add the link below for me to watch.  Please keep your video under 5 minutes.  I will not watch if its any longer and your application will be disqualified.
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Do you give Elliott permission to use your story / situation image and video for educational purposes on his YouTube channel or social media?  *
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