Healing Through Love Session
Application For Free Breakthrough Session
Please complete this simple form so we can provide the most benefit for you during our call. Dr. Erica will contact you to schedule a phone or Zoom consult.
Name
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First Name
Last Name
E-mail
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Phone Number
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Area Code
Phone Number
Address
Street Address
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City
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1. What inspired you to contact me today?
2. Briefly explain your CURRENT health, relationship, success or other life issues you would like to improve.
3. Briefly describe your IDEAL health, relationship, success or lifestyle you want.
4. Briefly explain your STRUGGLES, difficulties and problems that stop you from creating your ideal health, relationship, success and desired lifestyle.
5. Rate your current level of distress from 1 to 10 (1 = the worst, 10 = the best)
6. Anything else you want to tell me before our call.
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