The Circuit Breaker Advantage
™
Application
Enter Your Full Name
*
Your Phone Number
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Enter your Email Address
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What is the issue you are facing?
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Drugs
Alcohol
Gambling
Pornography
Other
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How much are you using and how regularly?
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What are your top three triggers? Here's some examples. Money, relationships, trauma, family, mental health and work
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What are your top three motivations for doing this work? Here are some examples. Improved finances, health, relationships, career and reaching your potential.
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Do you have the support of family, friends or relatives if you decide to take this journey?
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Type your answer here...
Yes
No
It's complicated
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How would you describe your current financial situation?
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Type your answer here...
Working earning more than 80k a year
Working earning less than 80k a year
Studying and working part time
I'm unemployed
I have access to super and or family funds for my recovery
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Conrad Tracey
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Circuit Breaker Application
