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Name, Surname And Age
Your email
Where Are You From?
Scale Of 1 - 10. How Committed Are You To Resolve Your Challenge? 12345678910
Are You Currently Making Use Of Chronic Mental Health Medication? If Yes Please Provide The Names:
Are You Currently Seeing Another Mental Health Care Practitioner? If Yes Please Provide Me With A Contact E-Mail Of The Said Practitioner.
Give Me A Short Description Of Your Challenge/ Problem/ Desire/ Goal You Want To Discuss During The Free Coaching Programme: