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 > http://bit.ly/2kxU0RQ
> Download our FREE training: The Broken Picker Solution, Stop Dating The Wrong Men NOW > http://bit.ly/2wN7KOE

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 *
MM
/
DD
/
YYYY
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)
IMPORTANT NEXT STEPS
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 >>> http://bit.ly/2kxU0RQ

>>> Download Raeeka's FREE training: The Broken Picker Solution, Stop Dating The Wrong Men NOW >>> http://bit.ly/2wN7KOE

If you have any questions email:
admin@datingwithconfidencecoaching

A copy of your responses will be emailed to the address you provided.
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service