Breakthrough Session Application

1. ➜

How to Use this Worksheet

Please type directly into the boxes after each question on the worksheet. When you're ready to move on, click "Save Your Answers" at the bottom of the page. This will save your answers so you can revisit them to finish or review your completed worksheet at any time.

2. ➜

What is Your Name?

3. ➜

What Is Your Email Address?

4. ➜

What Do You Most Want Support With?

5. ➜

What Are You Struggling With?

6. ➜

What Is the End Result You Want to Achieve?

7. ➜

What Are You Doing for a Living?

8. ➜

If after the Breakthrough Session you feel you are ready to receive more support from Benjamin in the form of coaching or mentoring, are you willing to invest the time, energy and financial resources to heal yourself?

9. ➜

Is there anything else that you would like me to know?

10. ➜

Thank You!

Thank you for completing this application. I appreciate your interest and honesty. There are a limited number of spaces available, so I only accept clients who I believe I can best support. No matter the outcome of this application, I pray that your healing journey be miraculously successful. I commit to continue supporting you through the Heal With Benjamin Community, E-Courses and other opportunities. Thank you for your understanding and support.

Much LOVE,

Benjamin

Save your answers

Enter your email address so we can save your answers for you:

Simplero