Apply for 4 Weeks Recovery Coaching With Amber

Tell us a little about your situation.

It should take between 10-15 minutes to answer these 10 questions. You'll hear back from us within one bussiness day.

Start

Question 1 of 10

Name, age, phone number, email address?

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Question 2 of 10

Tell me a little about the situation you're wanting help with?

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Question 3 of 10

What have you tried in the past? (counseling, treatment, 12-step meetings, other..)

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Question 4 of 10

Why is this the right time to address this problem?

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Question 5 of 10

What outcome are you hoping for?

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Question 6 of 10

Why do you think Amber is the right person to help you with this?

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Question 7 of 10

What will happen if you don't solve this problem?

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Question 8 of 10

Are you wanting to start this month or next?

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Question 9 of 10

Amber typically sees clients on Tuesdays and Wednesdays during regular work hours. Will this work for your schedule?

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Question 10 of 10

Anything else we should know?

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