Bridging Hearts 1:1

BRIDGING HEARTS™ 1:1 — APPLICATION FORM

Bridging Hearts™ 1:1 is a private, supportive session for women navigating intercultural or interfaith relationships. Together we explore your fears, patterns, and desires so you can feel safe, grounded, and confident in love again. Please fill in this form so that I can understand your story and support you in the deepest way.
Full Name*

First NameLast Name

Email*
exempel@exempel.se

What's your Instagram Handle @ ?*

What timezone are you in?*

Are you currently in a relationship?*

YesNoComplicated / on-off

Is your relationship intercultural, interfaith, or both?*

What faith/cultural backgrounds are involved?*

How long have you been together?*

What are you struggling with the most in your relationship right now?*

What makes things feel scary, confusing, or overwhelming for you?*

What fears or patterns do you notice about yourself in love?*

What do you wish you could understand about your partner, his faith, or his background?*

What feels unfamiliar or triggering for you?*

What would you love to experience in your relationship that you aren’t experiencing right now?*

If you could feel ANY way inside your relationship… how would that be?(Examples: grounded, safe, open, confident, connected, seen)*

What do you want for yourself as a woman?*

Why do you feel called to work 1:1 with me?*

What makes NOW the right time to receive support?*

Are you willing to invest time, energy, and resources into your emotional growth?*

Yes, I’m fully readyI’m nervous but committedI’m not sure / need clarity

If accepted, how soon would you like to begin?*

ImmediatelyIn the next 2 weeksIn the next monthNot sure yet

My 1:1 mentorship is a sacred, intimate space. Are you willing to show up with honesty, vulnerability, and openness?*

YesNo

What platform would you like me to reach out on?*

InstagramLinked InEmail

Anything else you want me to know about you or your relationship?*
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