Love Muffin Application

Complete this form so I can get to know you better.

Name *

First Name Last Name

E-mail *

Phone Number *

- Area Code Phone Number

What program are you applying for? *

LoveMuffin supports women in all 3 stages of relationship, which stage are you in now?

Phase 1: Relationship Readiness- I am not dating yet or I am dating and I don't like it. Phase 2: Feeling excited to date but am not sure how to do it or where to go to find quality partners. Phase 3: In a new relationship and I want to make sure it stays healthy and happy. I am not sure.

What are your biggest obstacles in finding and keeping love right now? *

What do you think is in the way of you having the relationship you want? *

Why do you want a relationship right now? *

What other areas of your life do you imagine will improve as a result of having a loving partner cheering you on in life? (health, wealth, productive at work, happiness) *

What have you tried so far? (classes, therapy, coaching, online dating) *

On a scale of 1-10 - How committed are you to learning what it takes to find love? *

If you are not a 10, describe what is in between your number and 10. *

Are you interested in creating a meaningful relationship in the next 6-12 months? *

Yes Not Sure

What about Love Coach Macy and/or LoveMuffin attracted you to reach out? *

If we see that coaching would be valuable for you to reach your relationship goals and decide we are a fit to work together, are you able to joyfully invest in my help?

Yes Not Sure No I don't invest in myself

You're done! Thanks for sharing! Click below to submit your form and on the next screen you will receive a link to book a time on my calendar! I look forward to meeting YOU.