PowerfuLove Application

Before you schedule, we'd like to learn a bit more about you to we're a good fit for one another.

First Name *

Last Name

Pronouns

Phone *

Email *

Partner's Name

To invite partner, click "Add Guest" at the bottom of form

How long have you been together? *

Are you or your partner currently struggling with any of the following? (Check all that apply) *

Why are you desiring to make these improvements NOW? *

Why us? Why do you believe that we may be the ones to help you? *

How "WORTH IT" for you is it to invest in growing, deepening, and strengthening your relationship? *

How committed are YOU to doing your part to co-create a relationship that delights you? *

100% Committed! I'm ALL IN!

I'm definitely committed and willing to work on us

I'm open to it

I'm on the fence

How committed is YOUR PARTNER to doing their part to co-create a relationship that delights them, too? (if you can't ask them, take a guess) *

100% Committed! They're ALL IN!

They're definitely committed and willing to work on us

They're open to it

They're on the fence

I have no clue at this point

PowerfuLove's programs range from $1,500 to $3,000 or more per (the investment is the same if we work with one or both of you). Our work is NOT THERAPY, and we do not accept insurance.

Understanding the above... if we make an invitation to join one of our programs, are you prepared to invest financially and energetically in a solution to create the relationship you desire? *

Yes

Possibly

Respectfully, please don't ghost us. These calls are a big investment of our time, energy, and love. If you no show for the call, you will not be able to reschedule.

Got it- I'll make sure to let you know if we decide to cancel or need to change

That's cool. I don't really want to improve my relationship anyway. (wink)

I confirm that I want to receive content from PowerfuLove using the contact information I provide.