Believe Be Real Client Questionnaire
Thank you for applying for relationship coaching with Dave Glaser, host of the BBR Podcast! We're looking for people just like you to become a part of our community and appreciate you taking the next few minutes so that we can learn more about your goals and desires for lasting love!
Email address *
Name *
Your answer
On a scale of 1-10, how important do you believe authenticity is in a relationship/dating/love? *
Your answer
What is the biggest thing holding you back in relationships? *
Your answer
Your Profession- How long, location, is it your dream job(s)? *
Your answer
Social Media Handles- Pick three most active for us to engage with you. *
Your answer
How long have you been in single or in your current relationship? *
Your answer
Address- Number, Street, City, State, Zip Code *
Your answer
Cell Phone Number *
Your answer
How do you prefer to connect with Dave? We will most often times connect via zoom for 30 or 60 minutes depending on how much coaching you desire. *
Do you have Previous Counseling or Coaching Experience *
Do you meet people online, in-person, or are you intentionally single to focus on yourself? Explain why also please! *
Your answer
Activiites, hobbies, books you've read, events you attend *
Your answer
The next four questions are based on the four pillars of strength of a relationship. Identifying where you believe you are on these scales will up us coach you 100% effectively in a shorter time period! On a scale of 1-10, how would you rate your physical health? *
On a scale of 1-10, how would you rate your emotional health? *
On a scale of 1-10, how would you rate your mental health? *
On a scale of 1-10, how would you rate your financial health? *
What (2) Two Other singles do you know that would benefit from speaking with us right now? Please give brief description of why they would be a great fit for coaching with Dave as well.
Your answer
Please add our email to your contact list so that you will never miss any communication from us! *
A copy of your responses will be emailed to the address you provided.
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