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How committed are you to changing your relationship with alcohol? *

Just curious

I’ve been thinking about it for a while and want to see what options are available

I’m pretty sure I want to stop drinking but not sure if I’m ready

I am ready and committed to changing my relationship with alcohol soon but not yet

I am 100% ready to break free from alcohol and take control of my life now

Have you attempted to stop drinking previously? (Choose 1 or more) *

What is the main reason you want to change your relationship with alcohol? *

It’s causing me stress, guilt, anxiety, and shame

It’s ruining relationships

It’s affecting my work

It’s damaging my finances

I’m tired of not being in control

Someone else wants me/is forcing me to quit

What is your annual income? *

Under $50,000

$50,000 - $100,000

$100,000 - $150,000

$150,000 - $250,000

Over $250,000

First Name *

Email *

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