Application
Hello! Welcome to the Women Can Heal community! I'm SO glad you are interested in learning more about Date With Depth. Please take some time to fill out your application for Date With Depth. Once received I'll reach out to you to schedule a call to talk about the program with you to see if (a) it is a good fit (b) answer any questions you may have. Spots are limited. Take a moment to reflect before submitting your application and ask yourself, "Do I really want to transform my love life right now?" If the answer is YES please proceed!
Email address *
First Name *
Your answer
Last Name *
Your answer
Email *
Your answer
Home Phone (for scheduling a follow up) *
Your answer
Age *
Your answer
Briefly describe your love life right now. *
Your answer
What is most challenging in your love life? *
Your answer
What have you tried so far? *
Your answer
One year from today, what do you want in your love life? *
Your answer
Why do you think what you wrote above isn't happening right now? *
Your answer
Why do you think what you wrote above isn't happening right now? *
Your answer
Why do you think Date With Depth could help? Rate your commitment to change, 1 is the lowest and 10 is the highest. *
Your answer
I am accepting a limited number of participants for Date With Depth. I will select participants based on those I feel are an ideal fit and in the best position to do the work and get results. Cool? :-) *
Your answer
If accepted are you prepared to invest financially in the program? *
Your answer
If YES, how much per month are you able to invest in yourself? $500-$1K, $1K-$1.5K, $1.5K or higher *
If no, please share why. *
Your answer
Is there anything else you would like me to know? *
Your answer
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