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EFT Quick Call Questionnaire

Please note that all fields followed by an asterisk must be filled in.
First Name*
Last Name
E-mail Address*
What are the most prominent negative emotions you're feeling at this time?
Describe the situation that's causing these negative emotions.
Can you think of a time you had success in a similar situation? If so, please describe:
If you were to ask for a desired outcome, what would your request be?
Other comments:

Please enter the word that you see below.