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Waitlist for Rachel Hart Coaching
I currently have a waitlist for my 1 on 1 coaching spots. Fill out the form below and when spots open up I'll reach out!
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* Indicates required question
First and Last Name
*
Your answer
Age
Your answer
Where do you live? (city, state, & time zone)
*
Your answer
Best email to reach you?
*
Your answer
Best phone number to reach you?
*
Your answer
Highest level of education completed?
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High school degree
College degree
Graduate degree (PhD, JD, MD, MBA, MFA, etc.)
What is your profession?
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Your answer
What's your combined annual family income?
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less than $50,000
$50-$100,000
$100-$150,000
$150-$200,000
$200,000+
Are you currently drinking?
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I am drinking.
I am not drinking.
How many days of the week do you drink on average? (If you are on a break, use your pre-break average.)
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0
1-2
2-3
3-4
4-5
Everyday
How many drinks do you consume in an typical sitting? (If you are on a break, use your pre-break number.)
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0
1
2
3
4
5 or more
Why are you serious about changing your drinking now?
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Your answer
How determined are you to work towards change?
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Not Ready
1
2
3
4
5
100% Committed
Why did you select this number? (If it's less than a 5, what's holding you back?)
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Your answer
What have you tried in the past?
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Your answer
Why do you find it difficult to change your drinking?
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Your answer
What do you think has prevented you from changing your drinking thus far?
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Your answer
Why are you interested in coaching as solution to this problem?
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Your answer
What will success look like for you in 6 months?
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Your answer
Will you show up on time for our call?
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Yes
No
What's are you most excited about for your consultation call?
*
Your answer
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