True Love Session Breakthrough Session Questionnaire First Name*Last Name*Phone**Email** WHERE ARE YOU AT RIGHT NOW IN RELATIONSHIP?**SingleDatingNot Yet ExclusiveDating--CommittedOtherHOW SATISFIED ARE YOU WITH YOUR LOVE LIFE?*What Love Life?Not SatisfiedSomewhat SatisfiedVery SatisfiedLove of my LifeWHAT 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 now6 months from now1 Year from nowON 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 kidsI'm actively trying to have a baby now or soonI would love to have a baby in the next 5 years or soNoARE 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?*CAPTCHASpam Control: Please Type Letters Into The Box Above
