Full Name
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Email
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Phone
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Age
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How did you learn about coaching with me?
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Newsletter
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Tell me more about your current situation or challenge
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Why do you think I can help you overcome this situation or challenge?
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Have you worked with a coach/therapist before?
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On average, how would you rate your daily level of self-confidence out of 10 (1 being extremely low self-confidence - 10 being extremely high)
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On average, how would you rate your daily levels of anxiety/stress out of 10 (1 being extremely low amounts of stress/anxiety - 10 being extremely high)
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