Ex Back Questionnaire

1

Please fill out the short form below so we can determine the best win-back-your-ex strategy for you:

2

How long ago was your breakup?* This field is required.

Less than 1 month

1-3 month

3-6 month

over 1 year

3

What was the main reason for the breakup?* This field is required.

Complicated Communication

Major Betrayal of Trust

Ex-partner said, 'no feelings anymore'

Different Goals, Values & Lifestyles

Complicated Life Circumstances

4

Why do you want to win your ex-partner back?* This field is required.

5

How strong is your desire for your ex-partner affecting you right now?* This field is required.

Very strongly, it's almost unbearable!

I find myself thinking about it more often.

I only get emotional occasionally.

6

What have you tried so far to win your ex-partner back or manage your heartbreak?* This field is required.

7

If you knew that having someone guide you through this could change everything - would you want that kind of help?* This field is required.

Yes, I know I can’t do this alone anymore—and I’m ready to get real support.

Maybe. I’m open, but I still have questions about how coaching works.

I’m not sure. I’m still trying to figure out if this is what I really want.

No, I’d rather try to handle this on my own for now.

8

What has been holding you back from rebuilding contact with your ex-partner?* This field is required.

I’m afraid of rejection

I don’t know where to start

I’m unsure if I’ll get another chance

He/She has already started seeing someone new

Blocked on all channels

Our last encounter ended in an argument

9

Let Us Help You Reconnect with Your Ex* This field is required.To provide personalized advice and guide you through your unique situation, please share your contact details so we can support you.

Full Name

Whatsapp Number

Email

In which city do you live?