Private Relationship Coaching Application

1
What is your full name?* This field is required.Enter your preferred first and last name.
First Name
Last Name
2
What is your email address?* This field is required.Please enter the best email address to contact you with.
example@example.com
3
What is your Instagram (or Facebook) address?* This field is required.Please enter the full web address of your Instagram (or Facebook) profile page.
4
What do you believe is the current problem in your life or relationships?* This field is required.Using as much detail as possible, describe what you believe to be the biggest problem in your life currently.
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5
What is blocking you from speaking and owning your truth throughout your life and with the people you love?* This field is required.Please describe (in detail) why you don't feel as though you can be fully open and honest with those that you love.
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6
Have toxic or narcissistic relationships in your life affected you physically/mentally/emotionally?* This field is required.Please be as descriptive as possible.
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7
How you would like your life (or relationships) in your life to look and feel?* This field is required.Describe them using as much detail as possible.
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8
If you were to find peace and fulfillment in your life or relationships, how would things change for you?* This field is required.(Please be specific)
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9
Why is it so important for you to address these issues in your life now?* This field is required.What has created this urgency to fix or improve things?
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10
What are willing to do in order to have the peaceful and loving relationship (with self and others) that you deeply desire ?* This field is required.
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