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Apply to Work with Dr. Tasnuva
This is the Intake Form for the Waiting List to get inside Autism Transformation & Success programs
This is NOT a certification Program. You will be taught our proven system to help your child recover from their developmental difficulties.
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Email
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Your email
Have You Read The PROGRAM DETAILS page THOROUGHLY yet? If Not, You will be declined your call and spot if you haven't read the Full Page carefully.
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Yes
Not yet. Then please go to
www.autismsuccessacademy.com/programs
Full Name of Guardian
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Your answer
Country of residence.
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Your answer
Where did you Find us or Heard about us?
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Your answer
WhatsApp Number
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Your answer
Full Name of Child plus Age
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Your answer
Detailed Diagnosis of your child?
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Your answer
What Have You Tried So Far?
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Your answer
What are your Current Struggles with your child?
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Your answer
Top 3 Goals you want to reach for your child?
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Your answer
What are some of the things holding you back from reaching those goals?
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Your answer
Why Do You Think We are a Good Fit to work together?
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Your answer
Why Do You Think NOW is the best time for You to join our Elite Program?
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Your answer
What is your level of education and understanding about Health science & brain development?
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Beginner
Intermediate
Well Versed &/ Health Professional
Monthly Household Income
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1000-2000 USD
2000-4000 USD
4000& above
How MOTIVATED & COMMITTED are you towards reaching your goals?
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I would rather wait and suffer
1
2
3
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5
6
7
8
9
10
I am ready for transformation
Which one of the following options best describes you right now divine parent?
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I want EVERYTHING to ensure best success & invest 5000 USD and achieve success in 6 months
I have some financial problems so I will like to join the distilled (self paced) version at 3000 USD
If you Do you have cash/credit or finance ready to go?
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Yes Dr. T I am ready to start now, Lets Join!!
I am almost there, about 1 Month
Not yet, I'll be ready in 3+ months
Is there anything else you want to share with us today? SHARE YOUR COUPON CODE if you have.
Your answer
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