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Dating Coaching

Dating sucks! That’s all I was going to say, but I should try to motivate you to do it, huh?
I mean… do you really want to be alone? LOLOL
Ok, let’s have some fun and find your true love!!

For *FREE* services, would you be willing to have your experience filmed/recorded for marketing purposes? *

Yes
No

By selecting Yes, you are giving me permission to use the video/audio for marketing on my social media platforms.

What services are you interested in? *

Dating coaching
Relationship coaching
Life coaching
Communication coaching
Venting

Have you ever hired a professional to assist with these services before? *

No, I'm new to this
Not yet, but I've been looking
Yes

Name *

First

Last

Age *

Phone number *

Your email *

State *

Zip code *

Gender *

Orientation *

I'm... *

Out of the closet
Mostly out of the closet
Partially out of the closet
In the closet

I... *

drink
don't drink
smoke
don't smoke
use drugs
don't use drugs
have sexual issues
don't have sexual issues
have family issues
don't have family issues
have work issues
love my job
am depressed
happy and content with life
have body issues
love my body
can't accept my sexuality
sexually aware of what I want
proud to be LGBT

When it comes to trying new things, generally I'm... *

not really interested
hesitant, but may give it a try
open to trying new things, sometimes
very open and ready to do it

What are some of your strengths *

Communication
Being outgoing
Thinking outside the box
Compromising
Being empathetic
Being creative
My sensuality
Being open-minded
Sense of humor
Speaking my mind

Specifically, tell me more about what brings you here. *

How long have you been dealing with the issue above? *

Less than 1 year
1-3 years
4-7 years
8-15+ years

Are you completely ready to commit to a resolution for your problem? *

Yes, I'm ready!
I'm hesitant, but it needs to be done
I need your services to hold me accountable, I may back out

By selecting "Yes" to agreeing to having your experience documented or filmed in exchange for free/discounted services, this means that you are granting me permission to use the audio/video for marketing purposes on my social media platforms. This is not a gaurantee that it will be filmed or posted online, this just serves as a release, just in case it is used. *

Yes, I understand and I give you permission to document our sessions to use for marketing

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