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TELL ME WHAT'S GOING ON.
This is a short set of questions that helps me understand what you are currently experiencing. The more honest you are, the more I will be able to help you.
Takes less than 5 mins.
1. First Name
*
2. Last Name
*
3. Mobile Number
*
4. Email
*
5. Instagram Handle
6. Which addiction/s are you currently experiencing?
*
Alcohol or Drugs
Smoking/Vaping
Gambling
Sex/Porn
Gaming
Internet/Social Media
Food
Shopping
Something else
If something else, please write it below
7. In your own words, how is it showing up in your life right now?
*
8. If we could wave a magic wand and have this problem disappear, how would you know?
*
9. What do you do for work?
*
10. On a scale of 0 to 10, how much are your habits currently affecting your work or daily life?
*
0
1
2
3
4
5
6
7
8
9
10
11. What made you decide to reach out at this point?
*
12. Is there anything else you'd like me to know before I read your answers?
*
Thank you for your honesty.
Lets Go
