Dating Skills & Needs Assessment!

This is your First Step in finding the Love of your Life and having the Life of your Dreams! Please Fill out and submit this brief form so you can get started in the process. We will get in touch with you shortly (usually within 24 Hrs) with your results and to go over any questions you may have. Please look out for an email or phone call from me today and tomorrow, and respond promptly as I have a limited number of clients I can serve at a time and availability changes daily due to high demand, so they are given on a first-come, first-served basis. Thank you, and I look forward to speaking with you!

Dating Skills & Needs Assessment

1. Your Name(required)
2. Email Address
3. Best Phone #
4. Age
5. Occupation
6. Present Status
7. Single
   Divorced
   In Relationship
   Married
   
8. What are your Biggest Challenges you're having presently?
9. What are your Top Goals?
10. Getting an Active & Successful Dating Life
    Finding "The One!"
    Enhancing Confidence, Dating & Attraction Skills
    Getting over Ex or Divorce
    
11. Other:
12. Any Areas or Skills you Most want to Improve on?
13. Any Secondary Personal Goals you want to work on?
14. Confidence
    Weight Loss
    Health
    Career/Income
    Social
    Personal Growth
    
15. Ideal Timeframe to achieve these goals?
16. Are you Ready to change your life Now?
17. Yes! I'm in. No. I'll procrastinate.

 

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