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FREE Analysis Survey

 

 

 

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Please answer the following questions to help in determining what level of support you currently require:
What areas of your life could be improved?
What would you like to work on RIGHT NOW that would make the biggest improvement in your life and health?
If you were living your BEST LIFE - what would be the first thing you would change?
What would you like to have more of in your life?
What would you like to have less of?
Name three things you are currently doing that do not support the life you'd like to live?
What do you feel you're simply tolerating in your life today?
What do you see as the biggest obstacle to the change(s) you'd like to make?
What area of your life would receive the biggest impact from the change(s) you'd like to make?

PERSONAL INFORMATION
*First Name:
*Last Name:
*Age:
*Gender:
*Address:
*City:
*State:
*Zip:
*Day Phone:
Best method, days/times
to contact :
*Email:
Comments:
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