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12-Week Alcohol Freedom Pilot Program Application

Apply only if you’re ready to make alcohol irrelevant and take full responsibility for your change!

First and last name (or last initial)

Email

Instagram handle

Why do you want to be alcohol free NOW?

What have you tried before, and what was the outcome?

What has gotten in your way when you've tried to change a habit?

What is the biggest change you made in your life?

What is your desired relationship with alcohol?

What is your desired relationship with alcohol?
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On a scale of 1-10, how coachable are you?

0 being "I know it already" and 10 being "show me the way"
On a scale of 1-10, how coachable are you?

On a scale of 1-10, how open to change are you?

0 being "no change for me" and 10 being "let's burn it all down"
On a scale of 1-10, how open to change are you?

Anything else you want to share about your Alcohol Free Journey so far?

Disclaimer

This program is coaching, not therapy or medical treatment. I don’t diagnose, treat, or provide medical advice. If you believe you have a medical condition related to alcohol use, consult a licensed professional. By applying, you acknowledge full responsibility for your choices and agree that results depend entirely on your effort, honesty, and participation.
By clicking the yes button below, you're agreeing to the disclaimer and that all of the information you've provided above is accurate and up to date to the best of your knowledge.
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