Believe Be Real Client Questionnaire
Thank you for applying for relationship coaching with Dave Glaser, host of the BBR Podcast! We love working with people just like you to help find lasting love and appreciate you taking the next few minutes applying so that we can help you find your ideal relationship and partner!
* Required
Email address
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Your email
Name
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Your answer
What is your top relationship goal?
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Flirt
Something Casual/Friends with Benefits
Dating for Fun/Exploration
Exclusive Dating
Exploring an Exclusive Relationship for Potential
Long Term Relationship
Marriage
Intentionally Single
Tell me honestly, why haven't you achieved your goals so far?
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Your answer
Describe your dream outcome regarding your ideal relationship and partner.
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Your answer
On a scale of 1-10, how willing are you to make a change right now?
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1
2
3
4
5
6
7
8
9
10
Cell Phone Number
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Your answer
Do you have Previous Counseling or Coaching Experience
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In-person Coaching
Small Group
Online Group Coaching/Counseling
One on One Zoom Coaching
Other:
Required
Do you meet people for romance online, in-person, or are you intentionally single to focus on yourself? Explain why also please!
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Your answer
Activiites, hobbies, books you've read, events you attend
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Your answer
How would you rate your physical health?
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1
2
3
4
5
How would you rate your emotional health?
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1
2
3
4
5
How would you rate your mental health?
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1
2
3
4
5
How would you rate your financial health?
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1
2
3
4
5
How would you rate your spirtual health?
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1
2
3
4
5
Please sign up for your free week by clicking
https://bit.ly/2DReJuB
and be sure to come back here and click submit on your form to schedule a complimentary 60 minute call with Dave one on one to discuss your specific challenges!
*
Done and done
A copy of your responses will be emailed to the address you provided.
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