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First Name*
Last Name*
Email*
Mobile Number*
Age*
Gender* FemaleMale
Occupation*
Please tell me about the challenge or challenges you wish to transform. Please share as little or as much as feels right for you in order to help us get started.* Some ideas of information you might choose to share include… What are the issues or challenges? How long have you had them? What are the steps you have already taken to address these issues? How much time and money have you already invested in transforming this challenge? Are you making good progress and want bigger, faster results, or are you feeling pretty stuck? What other info would help give me a basic idea of your situation?
I am seeing a mental health practitioner* YesNo
I am taking psychiatric medication* YesNo
Do you believe it is possible for you to completely transform or significantly improve your situation right away or over the next few months?* YesNoNot sure / Maybe
Where did you hear about us?* Agreements* I have read and agree to The Awakening Infinity.org Terms of Participation & Privacy Policy I have read and agree to The Awakening Infinity.org Terms of Conditions View Terms of Participation & Privacy Policy View Terms & Conditions If you need any assistance, please email us at [email protected].
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