This is a special session to help you get clear on where you are now and what’s standing in your way. I will share insight you can put into immediate use as well as discuss your coaching options and assess if it's the right next step for you, so you can receive a long-term transformation!

Must complete the form prior to booking session
All information is Confidential! 
Date: *

First Name: *

Last Name: *

Phone/Cell #: *

What is your Skype ID?
ONLY For inquiries outside of the United States.

Tell me about your OVERALL relationship challenge?  
What is your biggest frustration about not being in a meaningful relationship and how is it adversely affecting you?
(It's important to be SPECIFIC) *

On a scale of 1 -10, 10 being most urgent, do you want to be with your life partner / husband / soul mate? *

You want to be in a committed relationship in -- *


How long have you been single?  Or, not in a meaningful relationship? *

Select one (1)

Identify the chronic (challenging) patterns that have existed in your last 2-4 relationships. (It's important to be SPECIFIC) *

What behavior has plagued your relationships? *

What do you have a deep desire to transform so you can be in a satisfying relationship?   Do you know unfulfilling relationships and low self-confidence adversely affects your income potential *

Select one (1) - Your most pressing concern

On a scale of 1 -10, how confident are you in your sex appeal and attraction? *

Do you battle with the "Good Girl Syndrome"?  These are a set of beliefs you learned through your upbringing of how a woman should be humble, not sensual or sexual, etc. *

Which aspect of the "Man Magnet Blueprint" challenges you the most? *

What have you tried in the past to address this frustration? *

Select the one (1) that you have vested the most time, attention and money with.

What were the results of your past efforts *

Select the one (1) that you have vested the most time, attention and money with.

What did you invest in the therapy, coaching, personal development programs or retreats? (Cumulative Investment) *

Which program would you be interested in learning about? *

Select ONLY 1

Do you have a "commitment to self" mindset?  When you see you need help, you invest the time, energy or money necessary to get the help you need? *

Are you ready to put yourself first and invest the money to get the support you need? *

What have you allowed to stop you from making changes in your life? *

What are you ready to invest now to BE WITH your life partner / husband? *

Please explain if there is anyone else involved in the decision making of working with me. (spouse, parent or other family member, etc.) *

If coaching is solely your decision, indicate that below.
How did you hear about me?
If through another coaching colleague, click "Other" below and share their name *

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