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Home
About
Therapy & Coaching
Speaking
Contact Info
Online Course
Praise
Menu
Home
About
Therapy & Coaching
Speaking
Contact Info
Online Course
Praise
Consultation Form
First name:
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Last name:
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Email address:
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Phone number:
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Primary location and address for our records:
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Date of birth:
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How did you hear about Leslie?
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Have you worked with a coach, mentor, therapist or other provider before? If so, what were you receiving support with, and how was the experience for you?
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Please give us a brief sense of what has come up for you around reading When Change Takes Times: The eBook.
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What specific challenges or questions would you like to receive support with?
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Are you currently aware of how your past experiences might be contributing to your current circumstances?
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Please list any accomplishments that you’re proud of.
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Might you also interested in long-term work with Leslie?
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If yes, is fee a concern for you? Please let us know if you may need access to “sliding-scale” services and if so, share a little bit about your current financial circumstances so that we understand your needs.
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Is there anything else that you want us to know?
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