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1.  
To get started, what's your name?
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3.  
What's your work email?
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4.  
Your business phone number where your clients can contact you. 
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5.  
Please describe (in approx 100-250 words) your approach to marriage therapy/counseling/coaching.
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6.  
Please type in your website URL where people can land and explore your services. 
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7.  
Where is your clinic located? 
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8.  
Select your current license status.