Thank you for scheduling a time to speak with us. Kindly take a few minutes to complete our application, it helps us to best serve you during our time together.
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First Name
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Last Name
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Email
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Your daughter's name
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We work with girls ages 14-18, how old is your daughter?
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What is the main concern you have for your daughter?
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Select...
YES
NO
Is your daughter open to the idea of coaching?
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If you answered "No" above, please tell us more:
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Select...
I'm willing to do whatever it takes to help my daughter
I'm really interested in learning more, but not looking for an immediate solution
I clicked on this ad by accident, I'm not interested at all
What best describes your situation?
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Your appointment will be via Zoom and the link will be provided in your booking confirmation and confirmation email. Please commit to your appointment by typing this sentence in the box below: "YES, I will be ready for the Zoom call"
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In the event we have trouble connecting on Zoom, what is the best phone number to reach you at?
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Select...
Instagram
Facebook
Website
Other
How did you hear about us?
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If you answered "Other" above, please tell us more:
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I understand that if I cancel or reschedule my call within 12 ours of my call time, I forfeit my opportunity for a free Breakthrough Session in the future
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SUBMIT
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