First Name
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Last Name
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Phone
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Email
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Current Work
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How Long Have You Been Following Jill?
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Less than a week
Months
Years
What are your main challenges?
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Are you willing and able to invest right now?
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Yes
Depends
No
How committed are you to fixing this challenge in your life right now on a scale of 1-10?
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1 being not at all and 10 being very comitted
1
2
3
4
5
6
7
8
9
10
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