HEAL YES for women program application form
First Name
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Last Name
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Email
*
Phone
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Occupation
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Top 3 health goals
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Top 3 health issues you want gone
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How much have you invested in your health previously - be as specific as possible
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What have you tried so far that hasn't gotten you the results you want
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Are you tired of wasting time and money on band-aid "fixes"?
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HEAL YES!
No
Are you prepared to invest into your long-term healing?
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Yes, I know this is a 10x better investment than more "band-aids"
No, I prefer not to invest in my health
Are you 100% committed to showing up for the time that you book?
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HEAL YES! My health is worth it!
No, I am not ready to commit to in-depth testing and healing
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