EMMI FORTIN
Breakup & Relationship Coach
Relationship Assessment Call
Application
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid cell phone number.
Format: (000) 000-0000.
How would you like someone to follow up with you regarding your eligibility for a complimentary Relationship Assessment call? (Be sure you have entered the correct info above)
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Text
Email
Phone Call
Select all areas that apply regarding what you're seeking guidance with:
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Breakup / Divorce
Toxic Relationship or Situationship
Dating
Self-Esteem, Self-Love, Self-Acceptance
Forgiveness
Managing unhelpful repetitive thoughts or emotions
Communication in relationships
Breaking unhealthy relationship patterns
Setting healthy boundaries
Gaining clarity and understanding of relationship dynamics
Feeling happy alone / being single
Depression / Anxiety / Stress management
Designing a life you're excited about
Getting clarity about what you want in relationships or in life
Other
I only work with people who are a good fit for my services. This ensures the most success and transformational results. A GOOD fit for services are women and men who are growth minded, open to learn, and ready to implement a process that works so they can create the relationships and life they are destined for. Do you align with these values?
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Yes, I align with these
No, I do not align with these
I align with some of these
My services are NOT a good fit for women and men who want to complain about themselves, situation, or life but do not have the desire to change, grow, learn, or evolve, understanding that simply talking about your problems and taking no action is different from authentically sharing about where you are in life and taking action to help oneself. Do you align with this concept?
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I agree
I do not agree
My services are NOT a good fit for women and men who will not prioritize showing up for themselves and on sessions as recommended, understanding that prioritization and consistency helps build momentum, progress, and change. Do you align with this concept?
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I agree
I do not agree
My services are a GOOD fit for women and men who are ready to make an investment of their energy, time, and finances. They understand that in order to create a different result/outcome in their lives, they must implement a new method that works. What level of investment are you ready to make at this time to overcome your biggest challenge and get what you want?
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$0-$100
$100-$1,000
$1,000-$3,000
If you could get just ONE thing out of my services that would make it worth any investment, what would it be?
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Submit
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