Love and Confidence Session

Love and Confidence

Break-Through Session Application
Your Full Name*
Primary E-mail*
Your Best Phone Number*

Area CodePhone Number
Your Age*
Profession:*
City*
What is your biggest challenge when it comes to your romantic relationships? For Example, what are your current or biggest frustrations, complaints, or disappointments?*
What is the #1 outcome you want in your relationships? For example, what do you want to be able to do, to have, to handle, to fix, to solve, or to prevent? Or, what do you want to be clear about or free of*
On a scale of 1-10, how committed are you to transforming this within the next 90-120 days? *
Are you currently dating? If so, how soon do you want to be married/in a healthy committed long-term relationship?
Do you resonate with these statements? (check all that apply)

I want to break the narcissistic abuse cycleI am willing to invest resources to be powerful, whole and freeI am determined to write my own story and live a life of fulfillment
Are you struggling with any of these symptoms (check all that apply)?

AnxietyDepressionInsomniaMigranesLow Energy
Good work! You're finished! Just press the submit button below and we'll be on our way. You'll hear back from us shortly.
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