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Coaching Breakthrough Session
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Email
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Full Name
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Occupation:
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Phone Number
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Starting with most important, what are your top 3 health/life concerns that are blocking you from high performance? Ex. Fatigue, brain fog, weight gain, cardiovascular disease, relationship issues etc.
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Your answer
Why is it important for you to address the above concerns now?
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Your answer
What are your top 2 goals you have in life right now?
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Your answer
What strategies have you tried to address your concerns? Ex. Doctors, therapists, diets, cleanses, programs, specialist etc.
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Your answer
Please share a synopsis of your medical history. Ex. Medications, supplements, injuries, surgeries
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On a scale 1-10 with 10 being the best and zero the worst what would you rate the following:
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Sleep
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On a scale 1-10 with 10 being the best and zero the worst what would you rate the following:
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Nutrition
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On a scale 1-10 with 10 being the best and zero the worst what would you rate the following:
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Fitness
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On a scale 1-10 with 10 being the best and zero the worst what would you rate the following:
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Energy
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On a scale 1-10 with 10 being the best and zero the worst what would you rate the following:
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Brain Funtion - Focus and memory
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On a scale 1-10 with 10 being the best and zero the worst what would you rate the following:
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Stress level
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On a scale 1-10 with 10 being the best and zero the worst what would you rate the following:
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Relationship
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On a scale 1-10 with 10 being the best and zero the worst what would you rate the following:
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Spiritual Connection
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On a scale 1-10 with 10 being the best and zero the worst what would you rate the following:
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Financial
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What is your vision for your health and life? What would you like to feel and experience?
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Your answer
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