Authentic Mating & Dating Appointment Form Pre-Appointment Form First Name(Required) Last Name(Required) Email(Required) Please Select Your Call Preference(Required) Facebook Video Chat phone Phone Number(Required) Please share a little bit about your goals, your vision and wants when it comes to love and relationship.(Required)On a scale of 1-10 how much have you invested on this issue so far?(Required) 0-1 3-5 6-8 9-10 Exhausted myself trying to overcome this. What have you tried in the past and why hasn’t it worked? / What is your target love/relationship goal?What do you feel is the biggest obstacle to you hitting your goals?(Required) Fear of not being good at dating or good enough in general. Too many wounded people in the world. In the middle of life upheaval - drama, changes, turmoil. My kids. Work or not enough time. Motivation Other Briefly describe your self-love and worthiness practices that you are currently doing to support your confidence and self-esteem.Are you willing to invest in this process fully if we decide to work together?(Required)Yes! Absoluetly. I fully understand the power of investing into myself and committing to the process.I am unsure as to what I want or my commitment level.No, I am just exploring options at this time.Please share a little about your mindset going into this process.(Required)Have you ever worked with a coach before and how do you feel about coaching?(Required) Never worked with a coach - a bit nervous. Never worked with a coach but excited and hopeful! Yes I have worked with a coach before, but not a great expereince. Yes I have worked with a coach before, it was so-so. Yes I believe in the transformative power of working with a coach! Love it!! Please share what it means to you and your life to successfully achieve your goal and vision in love .(Required) Just for fun - get to know you 🙂 What's one fun quirky thing about you that makes you brilliantly unique?PhoneThis field is for validation purposes and should be left unchanged. Δ