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Information Form for Grief Breakthrough Session

Full Name:

Email:

Where did you find out about this free breakthrough session?

Where did you find out about this free breakthrough session?
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1. Can you describe the major loss (or losses) you've experienced that has had the greatest impact on your life?

2. On a scale of 1 to 10, how would you rate your current emotional state (1 = emotionally overwhelmed, 10 = emotionally stable and strong)? Please explain your rating.

2. On a scale of 1 to 10, how would you rate your current emotional state (1 = emotionally overwhelmed, 10 = emotionally stable and strong)? Please explain your rating.

3. What are the most pressing challenges you are facing concerning your losses?

4. Have you tried any other methods for dealing with your grief (therapy, self-help, support groups, etc.)? If so, what worked and what didn’t?

5. Why have you decided to schedule a call with me right now?

6. How would your life be different if you resolved your current challenges?

7. How much support do you currently have in your life (family, friends, community, therapy, etc.)?

8. Are you ready to invest money, time, and effort to grow yourself and create the life you most want?