Menopause Moguls Application
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Name: *
Email: *
Phone: *
Please list symptoms that you are struggling with. *
Which one of the symptoms bothers you the most? *
What business do you desire to start? *
What do you think is getting in your way? *
What is your current occupation? *
How did you hear about the Menopause Moguls™  online group coaching program? *
Required
What is the biggest takeaway you hope to gain and/or specific goal you wish to achieve once you conclude this program? *
Is there anything about the program that makes you nervous or apprehensive? (If not, type in N/A) *
Do you have any major medical conditions? If so, please list them.
Out of the symptoms that you are struggling with, which one bothers you the most? *
What aspect of the program are you looking forward to the most? *
Are you ready to invest in a process that will propel you forward to meeting your goals? *
Is there anything else you'd like for me to know before we begin working together? *
Have you taken other online programs or tried other things in the past? If so, please list them below. If not, write N/A *
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