Intentional Love Alignment™ – Readiness Assessment

1

Q1. What best describes your current situation?* This field is required.

Single & healing from a breakup

Single & dating

In a committed relationship

Married / long-term partnership

2

Q2. What feels most challenging right now?* This field is required.

Letting go of the past

Attracting emotionally available partners

Repeating the same relationship patterns

Communication & emotional disconnect

Deciding if this relationship is right

3

Q3. How often do you notice the same emotional pattern repeating?* This field is required.

Almost every relationship

Sometimes

Rarely

This is new for me

4

Q4. How emotionally ready are you to do intentional relationship work?Scale 1–10

5

Q5. If nothing changes, where do you see yourself in 6 months?* This field is required.

Still stuck in the same cycle

Emotionally exhausted

Settling out of fear

Clear and aligned

6

Q6. Are you willing to commit to weekly alignment work if recommended?* This field is required.

Yes

Possibly

No

7

Q7. Which investment range feels realistic for intentional support?* This field is required.

Under $500

$500–$1,500

$2,000+

8

Name* This field is required.

First Name

Last Name

9

Email Address* This field is required.

example@example.com

10

Phone NumberOptional but recommended

Please enter a valid phone number.