Wufoo
Application for Breakthrough Call with Virginia
Just answer the questions below and we'll get your breakthrough call scheduled.
How does your anxiety/fear/overwhelm show up in your life? What problem(s) is it causing?
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What do you want to accomplish in addressing your anxiety/fear/overwhelm over the next eight weeks?
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What have you tried so far to resolve your anxiety/fear/overwhelm, for how long, and how did these methods work for you? (Example, psychotherapy for 10 years, results; medication for 6 months, results; stress management course for 8 weeks, results.)
How much money have you spent in the last 3 to 6 months trying to overcome your anxiety? (Counseling, coaching, classes, books, medications/supplements, etc.)
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Name
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Phone Number
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Email
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Country You Live In
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