Complete For A Complimentary Consultation
What Is Your First Name?
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What Is Your Last Name?
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What Is Your Email?
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What Is Your Phone Number?
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What is your son's name?
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How Old Is Your Son
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18
19
20
21
22
23
24
25
26
27
28
29
30
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Your Son's Current Education
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Son's Current Education
No High School Diploma/GED
Not Enrolled In College
Failed/Academic Suspension
Enrolled Part-Time (4–11 credits)
Enrolled Full-Time (12+ credits)
AA Degree
BA/BS Degree
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Your Son's Employment Status
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Sons Employment Status
Full-Time
Part-Time
Unemployed, Looking for Work
Unemployed, No Desire to Work
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On a scale of 1–10, how ready are you to financially invest in helping your son?
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1
2
3
4
5
6
7
8
9
10
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Does your son live with a sense of purpose?
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Yes
No
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Does your son need more opportunities to succeed?
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Yes
No
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Does your son use video games to avoid life?
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Yes
No
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Does your son struggle with pornography?
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Yes
No
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Does your son avoid social situations?
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Yes
No
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Does your son experience high levels of anxiety daily?
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Yes
No
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What 3 areas would drastically impact your son's health & happiness?
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Employment
Social Engagement
Mental Health
Finances
Nutrition
Exercise
Hygiene
Sleep
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Are you willing & able to invest $9,000-$12,000 a month to help your son?
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Yes
No
What do you think is the biggest reason why your son has Failed to Launch?
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What is the best time to reach you?
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Morning (9am to 12pm)
Early Afternoon (12pm to 3pm)
Late After noon (3pm to 6pm)
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How did you hear about us?
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Online Webinar
Facebook
Google
Therapist
Referral
Other
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What is your time zone?
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Pacific
Mountain
Central
Eastern
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