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Sherry Lynne, BCBC, CNC, SMC-C
Confidential, Complimentary Call with Sherry Lynne
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Upon receipt of this completed form, Sherry will contact you to set up your consultation.
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Name
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Address:
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What Days/Times are Most Convenient for You to Have Sherry Call You?
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How did you hear of Sherry?
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What Offer/Program Are You Inquiring About?
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Briefly Describe Your Obstacles, What Your Situation is and How It Affects Your Life and Health: (Emotional Eating, Relationships, Anxiety, Career Obstacles, Grief, Overthinking, Trauma, Domestic Violence, Feeling Overwhelmed, Stressed OUT!)
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What Emotional and/or Physical Concerns Do You Want Help With?
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Are you vegetarian?
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Are you allergic to vitamins, amino acids, other supplements, foods or other? If yes, please list them here:
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What is Your Desired Goal? How will your life change when these situations no longer exist? What will it FEEL like when you no longer are dealing with these issues? How will this affect your relationships and your family relationships? What will you be able to confidently do that you are not able to do right now?
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Have you been diagnosed with Bi-Polar, Schizophrenia or other mental illness?
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Are you taking antidepressants or other medications? If yes, please list here:
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Did you see Sherry's before-and-after stories of those who are experiencing life-changing results in similar areas you're seeking help in? Go to: http://www.sherrylynnecounseling.com/testimonials.html
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How ready are you to financially commit, to living the happy, healthy, successful, healthy, peaceful life God Has purposed for you in John 10:10: 1) I want to but I am scared (briefly describe your fear). 2) Now is not a good time for me and I do not have any finances available. 3) I'm all in and have financial resources available to start now.
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