Marie Chose Love Discovery Form
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Email *
Name *
Phone Number *
Time Zone *
This request is for... *
Reason for interest? (Please explain in detail why you or the person you are nominating needs coaching.) *
Have you, or the person you are requesting for, experienced any of the following in your personal history? (As a child or adult. Check ALL that apply.) *
Required
Do you now, or have you ever struggled with the following? (Check ALL that apply.) *
Required
Have you ever been diagnosed with any of the following? (Check ALL that apply.) *
Required
Tell me about your experience with those things. How are you seeing it manifest in your life? *
What if any Spiritual Beliefs do you currently hold? *
Required
How have these beliefs shaped you? *
Hw does this differ or align with how you were raised? *
I am...(Check ALL that apply) *
Required
Do you have any children? (Through birth, adoption, or marriage) Describe below. *
Fears I have about doing coaching, if any? *
Please share what you hope to experience/gain through coaching? *
Level of Commitment to do the work required in coaching? *
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