What services are you interested in?
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What are you comfortable in spending?
Choose OneLess than $40/sessionBetween $40-$70Above $70{"type":"select","name":"__generic","width":100,"value":"","size":"Normal","validation":"N1","validationMessage":"Please make a selection for this item.","options":"Choose One\nLess than $40/session\nBetween $40-$70\nAbove $70"}
Tell me a little bit about what brought you here?
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How did you hear about us?
{"type":"checkbox","name":"MarketingDiscoverCall","width":100,"value":"","size":"Normal","validation":"C1","validationMessage":"Please check at least one item.","options":"Google Search\nReferral (by someone else)\nChurch\nOther"}