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1
Name
First Name
Last Name
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2
Email
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3
How did you hear about me?
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4
Phone Number
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5
City/State where you live
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6
What is your current relationship status?
In a Relationship
Single
Its complicated
Other
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7
How happy and satisfied would you say you are in your current relationship?
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8
And why do you rate yourself that way? In other words, what do you feel is and is not working right now in your relationship?
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9
If you are not currently in a relationship, what would be your main goal in working with a love and relationship coach?
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10
What if any work have you done in the area of personal growth, such as other coaching, reading self-help books, attending workshops, etc.?
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11
What are the top two burning questions you have for your discovery session with me?
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12
What makes you and ideal client for me to take on right now? (What makes you coachable?)
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