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How may I serve you?
We need to get connected to talk about you! I look forward to the opportunities our work together will provide. Please complete this form. It will show me how to better serve you.
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Email
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First Name
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Last Name
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Phone Number
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Is it okay to text you?
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Email Address
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Is it okay to email you?
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Date of Birth
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What times are you available?
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Who referred you to me? We'd like to send them a thank you?
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Why are you here? What are your main areas you would like to focus and work on with me?
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How do you feel I can best help you? Check all that apply.
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Brainstorming ideas
Accountability partner
Motivation
Assist in self-awareness
Helping you identify and overcome challenges
Support and encouragement
Designing detailed plans to reach your goals
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