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!
Email address *
Name *
What is your top relationship goal? *
Tell me honestly, why haven't you achieved your goals so far? *
Describe your dream outcome regarding your ideal relationship and partner. *
On a scale of 1-10, how willing are you to make a change right now? *
Cell Phone Number *
Do you have Previous Counseling or Coaching Experience *
Required
Do you meet people for romance online, in-person, or are you intentionally single to focus on yourself? Explain why also please! *
Activiites, hobbies, books you've read, events you attend *
How would you rate your physical health? *
How would you rate your emotional health? *
How would you rate your mental health? *
How would you rate your financial health? *
How would you rate your spirtual health? *
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! *
A copy of your responses will be emailed to the address you provided.
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