(STEP 1 OF 2) COMPLETE THE APPLICATION BELOW BEFORE BOOKING YOUR CALL

Is alcohol negatively affecting your life?

What area(s) of your life is alcohol affecting the most?

What kind of a drinker are you?

How often do you drink?

When you do drink, how much are you drinking?

What else do you want to tell us about your drinking habits?

What have you done previously to work on your relationship with alcohol?

Tell us about your previous attempts to deal with your relationship with alcohol - what works, what didn't work?

What do you want to do about your relationship with alcohol?

If someone advised you on how to get that would you...

What is your current Job Title?

What industry do you currently work in?

What's your First Name?

What's your Last Name?

What is the best email to contact you at?

What is the best number to contact you at?

How did you find out about us?

I am...

Are you ready to solve this problem?

IAMACOMEBACK LLC