"Barrier Breakthrough" Questionnaire
Complete this form to qualify for a scheduled "Barrier Breakthrough" Call with Mario, to identify barriers to succeeding in your love life, and "better" strategies of action. IMPORTANT: Answer all questions as truthfully as possible. Tell your "tough" truths, so that he can best help you, and FASTER!)
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First and Last Name *
Best Email *
Phone Number *
Skype ID (if international)
Current Relationship Status *
What is holding you back from the love life you desire? Check as many as apply (naming the problem is a big step towards solving it) *
Required
What is/are your BIGGEST obstacle(s) to experiencing a fulfilling love life? (The more detail you give us, the better we can serve you on the “Barrier Breakthrough” call.) *
In detail, describe everything about your IDEAL love life. (Desired experiences, frequency, and level of connection) *
How long have you been struggling to experience the love life you desire? *
What have you tried in the past to try to overcome your romantic struggles?  *
Why do you believe your past dating efforts have not worked for you?  *
On a scale of 1-10 ('1' being low confidence and '10' being highest confidence), how confident are you that you’ll be able to drastically improve your love life (without help) over the next 60 days? *
No confidence
Full confidence
On a scale of 1-10, how confident are you that if you were to meet 'Mr./Ms. Right' tomorrow night, you could 1) recognize them, and 2) take SUCCESSFUL action? (The more detail you give us explaining your number, the better we can serve you on the “Barrier Breakthrough” call.) *
Please list MULTIPLE BLOCKS OF TIME (date & time) withIn the next 5 business days for us to schedule your Barrier Breakthrough session.   *
Mario will call you at the time of your appointment. Please confirm your intention to show up fully by typing this sentence in the box below, word for word. “I promise I will answer my phone for my “Barrier Breakthrough” session when my coach calls.” *
LAST - Who is your (current) celebrity crush, and WHY? *
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