What's stopping you from finding love?
About you, your dating, your relationships, & your love-life
These questions may help you start to understand your love-life.
You do not have to complete all the questions. Please complete as much or as little as your time and interest allows.
You can find out about me and my programmes here, or contact me and I will let you know how to get started:
http://www.bristolcounselling.co.uk/love-recovery
Email:
shelley_treacher@hotmail.com
Shelley Treacher MA Couns Psych BACP accred
* Required
Email address
*
Your email
About you: Tell me about your life right now (the details; Do you live alone? What's your job? Were you married? Do you have kids? Pets?)
Your answer
What does your typical day look like?
Your answer
What are your favourite parts about your life?
Your answer
What interests you on social media/ what groups are you a member of?
Your answer
About your lovelife: Tell me your story. What's your experience of relationships so far?
Your answer
What has dating been like for you?
Your answer
Describe one of your best dating experiences
Your answer
Describe one of your worst dating experiences
Your answer
When do you feel the sting of being single the most?
At home alone
At night
When I miss being close to someone
At weekends
At parties
In the park/ outside walking
On special occasions
When an occasion comes to an end
At certain times of the year
With relatives
Other:
Are there patterns that seem to repeat for you in relationship/ dating? If yes, please describe the pattern
Your answer
Tick as many as apply
I'm attracted to the wrong people
I just can't get going at all. Nobody seems interested in me
My dates are really interested at first but suddenly seem to lose interest completely after a while
I become jealous and obsessive. I just can't seem to help it.
My partners end up being very controlling
I find myself in relationship after a couple of dates, and then spend a lot of my time with my partner
I feel unable to say what i want.
I frequently feel hurt or disappointed.
I find it difficult to trust
I'm really interested at first, but lose interest soon.
I either find people physically attractive, or I like them as a person/friend. I never seem to feel both at once.
People I find attractive never seem to find me attractive, and vice versa.
I don't find many people attractive
Other:
Clear selection
Briefly, what was your childhood like? What, if any, incidents in your past, may have contributed to your patterns in relationship?
Your answer
Describe your ideal dating experience
Your answer
Describe your ideal partner and relationship
Your answer
Do you feel you have love in your life?
Your answer
What do you appreciate about your life?
Your answer
About your current support for dealing with dating and relationship: Who or what do you currently, or have you ever used, for support in this area?
Your answer
What’s working for you now? What do you like about it?
Your answer
About the future: How important is this for you to handle right now?
Your answer
What would get better in your life if your lovelife was a non-issue?
Your answer
About how to help you: Have you ever paid for a product or service to help with your dating or relationship situation?
Your answer
If not, what has stopped you?
Your answer
If yes, what did you like best about it?
Your answer
What do you wish companies/programmes understood about you to be able to help you?
Your answer
Would you pay for a programme designed to help you with your lovelife?
Yes
No
Maybe
Clear selection
If yes, how would you like this to be taught? (Tick as many as apply)
In person in a small group
In an online group ( a group internet call)
Online videos, audios and readings; fully self guided
With community support (eg closed FB group)
1 on 1 individual support
A mix of self guided options and group support
A mix of all
Other:
If I could wave a magic wand, and your lovelife was sorted, what would your life look and feel like?
Your answer
And finally! Would you like to be kept up to date with my offers, courses and writing on creating a fulfilling lovelife? * You can sign up yourself, here:
https://mailchi.mp/61f312b43b24/making-love-a-reality
*
Yes
No thankyou, not at this time.
Please let me know here if you would like a personal response from me (optional).
*
Yes please!
No thank you, not at this time
Next
Page 1 of 2
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms
