Dating Block Breakthrough Session
Email address *
Take a few moments to fill out this form to apply for a Dating Block Breakthrough Session with Raeeka.
In order to apply for a 20-Minute Dating Block Breakthrough Session with Raeeka you must be: 1)COMMITTED to solve your dating challenge now. 2) READY (as oppose to interested) to make a change now. 3) RESOURCEFUL. When you want something in your life you make it happen. Does this describe you? *
+++ If you answered YES to the question above, PLEASE CONTINUE TO FILL OUT THE REST OF THE FORM BELOW.

––– If your answer is not a YES to the question above, the 20-min Dating Block Breakthrough Session is not the right fit for you at this time. Here are some other FREE resources to support you in the meantime:
> Join “Dating Tips for Savvy Single Ladies” PRIVATE & FREE facebook group >
> Download our FREE training: The Broken Picker Solution, Stop Dating The Wrong Men NOW >

First Name *
Your answer
Last Name *
Your answer
Primary Phone for Raeeka to call you. (If you live outside of the U.S. we will email you instructions on how to call for your session) *
Your answer
Time zone *
Your answer
How did you hear about Raeeka? *
Your answer
Today's Date *
How important is it to you to create your love life right now? *
Not important to me
Extremely important to me
Explain why you chose the number in the previous question. (If you answered a number lower than 10, tell me what needs to happen for you to be at a 10):
Your answer
Describe the love life and relationship you want to have in the next 12 months. *
Your answer
What information do you feel like you are missing that would allow you to create the vision you described in the previous question? *
Your answer
Why do you think you haven't been able to have the described love life you want? *
Your answer
What is your profession? And do you think it has affected your ability to create the love life you desire? *
Your answer
How much have you invested on personal development, dating, or relationships in the past few years? (classes you've taken, therapy, personal work, healing, coaching) *
Your answer
Why is creating your love life importnat now? Is there a life circumstance or an event that has prompted that? *
Your answer
Is there anything you consider to be more of a priority right now than creating the love life you want? *
Your answer
I feel like everything else in life is going great, except for finding a quality guy (select your answer below that best applies) *
What's the reason for your answer above? *
Your answer
What do you do for fun? How do you spend your free time? *
Your answer
What's your most important dating challenge you want support around in our 20-minute session together? *
Your answer
As we know, no one's dating challenges can be completely solved in 20 minutes. At Dating with Confidence™ we take pride in helping our clients get results and create success in their love lives. Based on your conversation with Raeeka, she intends to discuss which Dating with Confidence™ programs might be a good fit for you to continue taking the work you'll be doing in this session to the next level. Is this a discussion you'd be interested in having? *
If you answered 'No' to the previous question, what was your reason? (choose any/all that apply)
Raeeka will review your application and if it looks like you are a good candidate, you will be provided with a link to book your Dating Block Breakthrough Session call with her.

IMPORTANT: To ensure you receive the link straight to your inbox, MAKE SURE to add admin@datingwithconfidencecoaching to your address book or simply star an email from her.

>>> Join “Dating Tips for Savvy Single Ladies” PRIVATE facebook group >>>

>>> Download Raeeka's FREE training: The Broken Picker Solution, Stop Dating The Wrong Men NOW >>>

If you have any questions email:

A copy of your responses will be emailed to the address you provided.
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