Podcast Interview Application

1

Are you aware of traumas from childhood (yours or your partner's) affecting your current relationship?* This field is required.

YESNO

2

Name* This field is required.

First Name

Last Name

3

Email* This field is required.

example@example.com

4

Phone Number* This field is required.

Country Code

Area Code

Phone Number

5

What’s great about your current relationship?* This field is required.

6

What do you have TOO MUCH of in your current relationship?* This field is required.Examples: Arguing, Blaming, Lying, Distrust, Shutting down

7

What do you have TOO LITTLE of in your current relationship?* This field is required.Examples: Affection, Communication, Intimacy, Sex, Appreciation,, Fun and adventure, Quality Time Together

8

Have you previously sought support for your relationship? What helped and what didn’t?* This field is required.

9

What kind of support do you think you need to really create the relationship you desire?* This field is required.

10

What do you do professionally? Your partner?* This field is required.

11

Please share social media links here* This field is required.Examples: Facebook, LinkedIn, Other

12

Are you willing to invest the time and resources needed to make your relationship thrive?* This field is required.

13

Are you open to sharing personal aspects of your relationship on our show, knowing it could inspire and support others while also helping you gain new insights or breakthroughs?* This field is required.

14

Suggested Guest 1 : Name

First Name

Last Name

15

Suggested Guest 1: Email

example@example.com

16

Suggested Guest 2 : Name

First Name

Last Name

17

Suggested Guest 2: Email

example@example.com

18

Suggested Guest 3 : Name

First Name

Last Name

19

Suggested Guest 3: Email

example@example.com