Basic Information

Name

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Email

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Phone

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Age range

Please select an age range.

What does dating look like for you right now?

Select all that apply.

Single, not dating Single, actively dating On the apps Recently out of a relationship Talking to someone new Rebuilding after a long pause In a healthy relationship, but want to make it even better In a relationship, but things aren't going well

Your relational history

This is for context, I pass absolutely no judgment. The more honest you are, the more I can help.

In just a few sentences, what have your significant relationships looked like?

How did they tend to begin? How long did they last? How did they tend to end?

A few sentences here helps a great deal.

Is there a pattern you notice repeating across relationships?

The same fight, the same type of person, the same point where things break?

How long since your last relationship ended?

Please select one.

What gets in the way?

The honest part. The clearer you are here, the more useful our work will be.

In your own words, what is the single biggest obstacle?

Please tell me the main obstacle.

How have you tried to improve in this area?

Have you tried therapy, other coaching, books, apps, advice from friends, going it alone?

Where are you headed?

Where are we aiming, and how will we best work together?

If our work together went well, what would be different in a year?

Please share what you're hoping for.

Which best describes what you want?

Long-term commitment Date with more confidence Understand my patterns Improve my attractiveness Recover from a breakup Not sure yet

Please choose one.

Preferred session pace

Please select a pace.

Is there anything else you want me to know? (optional)

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