Let's find out About Your Needs Before Our Call!

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Please complete these quick questions to know how I can best help you get over your breakup faster.

Please, ignore Google's message about signing in before!

My name is .... *

Marital Status *

Single

Separated

Divorced

Cohabiting/Married

Do you have children? *

Yes

How long ago did the relationship end? *

Less than 4 months ago

Between 5 and 8 months ago

Between 9 and 12 months ago

Between 1 and 2 years ago

More than 2 years ago

Where do you live? *

In the USA

In the UK

Other:

What method did you try to recover from your breakup? (check as many as they are applicable to you) *

Read blogs and articles on the Internet

Participate in Facebook groups or Internet Forums

Talk to friends and family

Go to therapy

Keeping myself busy as much as possible

Become involved in pleasurable activities

Develop new hobbies or personal connections

Rebuilding my self-esteem

Journaling

Other:

Required

Why do you think everything you tried hasn't worked? *

List at least 3 issues that you struggling with regarding your breakup that you would like to eliminate? *

Have you already received therapy for this breakup? *

Yes

Please select the 3 MOST IMPORTANT CHARACTERISTICS for you to consider a breakup therapy program: *

The program would need to be developed by an expert in the field, like you are.

The program would need to be endorsed by many people (e.g., testimonials) or recommended

The program would need to be affordable

The program would need to be using scientific, psychological techniques

The program would need to be easy to follow and not needing too much time

The program would need to be proven to work based on a previously published scientific study

Other:

Required

I have designed 3 different breakup programs, each one contains different content. Once we talk, I will be recommending the most appropriate for you, are you determined to work on your breakup and invest financially to recover? *

YES, I'm committed to work on my breakup and I am willing and able to invest financially to get over my ex.

YES, I'm committed to work on my breakup but I am unsure about investing financially in my recovery. It depends on the investment.

SO, SO, I "want" to be committed but I don't know if I feel strong enough. I could invest financially in myself if the program motivated me enough..

NO, I don't want to invest financially in anything.

Can you please suggest a range of dates and times that may work for you? (we'll have to take into account time zones, I am in Spain) *

What's your telephone number? (with country code) *

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