Rewire Your Brain 
 Hello my Dear , I'm Dr. Sakshi Shrivastava- A High Performance Expert and Mental Wellness Coach , please feel free to fill this form so that i can connect with you and understand you better.

                         !!!!! LOOKING FORWARD TO WORK WITH YOU !!! WE CARE FOR YOU !!!!

Email *
Name *
Address *
AGE *
SEX *
Phone number *
Occupation *
Is there any current issue you are dealing with? *
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What is your biggest fear to deal with any related issues?  *
What you have tried so far that is not worked for you? *
What is your biggest fear when it comes to related issues?  *
What is holding you back ? *
What are you struggling with ? *
what worries you or what are you afraid will happen if  you if you do not do something immediately ? *
What would be you willing to do to solve / get resolved with the issues you are facing ? *
If you could have one question answered about your related issues - what it would be ? *
How much desperate you are to transform yourself on a scale of 1 to  10? *
How much Accountable you feel you could be during the entire journey on a scale of 1 to 10 ? *
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