True Love Session Breakthrough Session Questionnaire First Name* Last Name* Phone** Email** WHERE ARE YOU AT RIGHT NOW IN RELATIONSHIP?** Single Dating Not Yet Exclusive Dating--Committed Other HOW SATISFIED ARE YOU WITH YOUR LOVE LIFE?* What Love Life? Not Satisfied Somewhat Satisfied Very Satisfied Love of my Life WHAT IS YOUR BIGGEST CHALLENGE IN YOUR LOVE LIFE/DATING LIFE RIGHT NOW?**WHAT HAVE YOU TRIED IN THE PAST TO IMPROVE YOUR LOVE LIFE/DATING LIFE?**WHAT ARE YOU LOOKING FOR IN YOUR IDEAL RELATIONSHIP?**WHEN DO YOU WANT TO BE IN AN EXTRAORDINARY, EPIC, LOVING PARTNERSHIP? ** 3 months from now 6 months from now 1 Year from now ON A SCALE OF 1 TO 10, WITH 10 BEING 100% COMMITTED, HOW COMMITTED ARE YOU TO FINDING LOVE?** DO YOU HAVE OR WANT TO HAVE BABIES? ** Yes, I have kids I'm actively trying to have a baby now or soon I would love to have a baby in the next 5 years or so No ARE YOU READY TO HIRE A COACH AND INVEST YOUR FINANCIAL RESOURCES INTO TRANSFORMING YOUR LIFE?** PLEASE COMMIT TO YOUR APPOINTMENT BY TYPING THIS SENTENCE IN THE BOX BELOW: "YES, I PROMISE I WILL CALL THE ZOOM LINE FOR MY BREAKTHROUGH SESSION AT MY BOOKED APPOINTMENT TIME :-)** ON A SCALE OF 0 TO 10, HOW EXCITED ARE YOU TO TALK TO MIRA AND TO FINALLY FIND THE MAN OF YOUR DREAMS AND HAVE LASTING LOVE?* Δ
