Full Name
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Email
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Phone
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Are you currently dating online?
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Yes
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What is your ideal relationship like?
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How important is being in a relationship to you on a scale of 1-10?
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What are your current challenges in relationships?
Just getting started
Communication
Fear / Anxiety
Next steps
Any other challenges you are experiencing?
Have you ever worked with a relationship coach before?
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Yes
No
What is your ideal timeline for our Discovery Call?
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Immediate
Within the next week
Within the next few months
Just exploring options
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