Which area do you struggle with most?
Overwork Drugs Sex Alcohol Money
What triggers these behaviors for you?
Stress Loneliness Peer pressure Boredom Financial strain
Have you sought professional help before?
Yes No
How important is building resilience to these issues for you?
Extremely important Very important Slightly important Not important
All set, how can we reach you?
Name
Email
Phone
(Details here)
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