EmailMe Form - Single You Academy Application

Name *

First Last

Age *

How long have you been following me? *

a few days

at least 1 month

2+ months

Do you feel like: you have your life together (career-wise and financially) you're doing alright. *

Absolutely

Not a all

I'm pay check to pay check

Have you been actively trying to figure out what you're doing wrong in relationships?? (Googling, listening to podcast, reading etc)

Yes

No

No but I'm ready to figure it out now

In your past relationship(s) would you say you: *

Passed up his Red Flags

Fell for his potential

Minimized yourself for him

All of the above

Would you say that with most guys you can set boundaries with. It's just when you actually like a guy all your rules seem to go out the window? *

That's so me

I can't set a boundary with any man

I've never done that

How many times have you written him off only to find yourself back with him/not breaking up with him? *

Often

Too many times to count

Never

Once

What have you tried to stay out of a dysfunctional relationship? *

Has anyone ever had a conversation with you about what makes a healthy relationship vs. an unhealthy relationship? *

Yes

No

Yes but not very well

Do you have or have you had a therapist? *

Yes

No

What do you need guidance and support in the most right now? *

Understanding who I am, my worth and being able to execute that with my actions

Setting boundaries

Understanding the difference between healthy vs unhealthy (relationships)

All of the above

Where do you want to be 3 months from now? *

Knowing my worth and not settling

Having the ability to set clear boundaries and keep them

Free from the cycle of dysfunctional relationships

All of the above

In love with myself

to be able to slow down the dating process

The investment for my services is $3500 (payment plans available).

If this number scared you and made you want to cancel this questionnaire, don't! Aren't you here for a reason? Is healing/changing this area in your life a priority or no? *

Yes, I understand the value of investments, I am excited to learn more

Yes, I'm ready to invest (will definitely need payment plan)

Not ready-don't have the cash or the commitment level

Be honest. We don't have to waste each other's time. Are you truly ready to make the investment? And if your application is approved, are you committed to showing up to the call on time? (serious inquires only) *

Yes

No

Anything else I need to know?

Email *