Step Into Healthy Love VIP Application for Challenges

First Name*

Last Name*

Phone Number:

Area CodePhone Number

E-mail*

example@example.com

City*

Street Address

Street Address Line 2

State/Province*

Street Address

Street Address Line 2

Country*

Street Address

Street Address Line 2

Age*

Occupation*

How did you find out about us? If someone referred you, please give us their name here so we can thank them!*

What's your relationship status?*

Single - Never MarriedDivorcedWidow/WidowerOther

How long have you been dating and wanting to find the right one?*

Select which of these best describes you: (select all that apply)*

You’ve struggled in relationship patterns with people who looked good at the begining but turned out to be emotionally unavailable in one way or another (narcissistic, liar, cheater, commitment phobe).You are successful in so many areas of your life except love and intimacy. You didn’t have healthy parental modeling or healthy examples and/or you’ve experienced trauma in the past.You distract yourself with your career, friends, food, hobbies, kids or the gym.You feel as though you are intimidating to men, and that the kind of smart inspiring, and emotionally available person you really want isn’t available where you live, that the good ones are taken or that you keep seeing the same people on the dating sites.You don’t like online dating apps and don’t trust that good matches exist on them.You value high-level support and intuitive coaches so you can break through your own inner glass ceiling.

What is your goal and vision for your love life? What do you want to achieve in the next 3-6 months? What would it mean to you to find your true love and ideal partner? What would your life look life if you achieved your goal?*

How is not having true love in your life affecting you? What is it costing you emotionally, physically and/or spiritually?*

What do you think might be getting in your way in terms of finding "the one"?*

What, if anything, are you doing (or have you done) to overcome these obstacles? Why haven’t these approaches worked?*

How would you rate your overall life satisfaction now?*

I'm in a rewarding career I absolutely love.I have a job but it's a major source of stress and also a distraction.I'm unemployed and looking for a job.I'm a student.I'm happily retired.

On a scale of 1-10 how committed are you to invest time, attention, and financial resources to get support to transform and become the person who finds their soulmate? *

(1 = I'm not committed at all, 5 = I'm moderately committed, 10 = I'm fully committed now)

Please check which of these best describes your willingness to invest in removing any barriers to love and finding your soulmate with a plan: (choose one)*

I have the funds to invest in changing my love life.I have access to the funds to invest in changing my love life.I don't have immediate access to the funds but I am resourceful and willing to do whatever it takes to get the funds required to live my dream.I don't have any funds at all, and I want to keep my love life exactly how it is now.

Please check which of these best describes your willingness to invest in removing any barriers to love and finding your soulmate with a plan: (choose one)*

I have the funds to invest in changing my love life.I have access to the funds to invest in changing my love life.I don't have immediate access to the funds but I am resourceful and willing to do whatever it takes to get the funds required to live my dream.I don't have any funds at all, and I want to keep my love life exactly how it is now.

Have you ever taken any weekend workshops, attended retreats, seminar or lectures on spirituality, relationships or overall self improvement?*

YesNo

If yes, please describe what you have attended or experienced.

Is there anything else you want me to know before we speak?