Manifesting Love Application
Please answer each question thoroughly for consideration.
Client Name
*
First Name
Middle Name
Last Name
What are your pronouns?
Birth Date
*
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
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31
Day
Please select a year
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
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1929
1928
1927
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1925
1924
1923
1922
1921
1920
Year
Birth Time & Location
*
Required - if you do not know your birth time, enter 12:00am
Relationship Status
*
Please Select
Single, Never Been Married
Single, Divorced
Single, Widowed
It's complicated
Mailing Address (p.o. boxes are okay!)
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
E-mail
*
example@example.com
Mobile Number
*
Phone Number (if different from mobile)
Location
*
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Have you taken any personal growth seminars/workshops or had coaching before? If so, what helped you the most in those settings? What areas do you think you need to grow in order to manifest love?
*
Do you have any aversion to spirituality? If so, please explain.
What ideas or beliefs did you grow up with about marriage, religion and sex? Do those ideas or beliefs resonate with you now? Why or why not?
What are you TOP 3 Favorite places to visit, foods, films and books? What makes them special to you? (in no particular order)
How do you describe yourself?
Introvert (100%)
Extrovert (100%)
Ambivert (a blend)
Tell me about your last 3 relationships. What did you learn about yourself? Do you have any remaining energetic attachments with those people?
Have you had any form of energy work over the last ten years? Did you love it? If no, why not? If so, what did you experience?
Describe your "type". .
Manifesting Love (1:1 Coaching) requires a certain level of honesty and integrity (that goes for both of us). On a Scale from 1 to 10, 10 being stellar, what is your relationship with your Word today? (If it is not so stellar, are you willing to change that?)
Do you want the VIP experience or the Basic experience? (Needed for scheduling and invoicing)
*
Please Select
Manifesting Love Basic (7 weeks) $999.00 (full)
Manifesting Love (12 weeks) $1,777.00 (full)
Manifesting Love (1:1 Coaching) is designed with your privacy in mind. I will not breach the confidentiality of our time together. Any sharing, for marketing purposes, will only occur with your written permission. Do you agree to honor the confidentiality as well?
Yes
No
Manifesting Love (1:1 Coaching) requires a commitment to yourself and requires your participation. Do you agree to show up, give your all and complete the course?
*
Signature
*
Submit Application
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