Tell me honestly, why haven't you achieved your goals so far? *
Your answer
Describe your dream outcome regarding your ideal relationship. *
Your answer
On a scale of 1-10, how willing are you to make a change right now? *
Cell Phone Number *
Your answer
Do you have Previous Counseling or Coaching Experience *
Required
Do you meet people for romance online, in-person, or are you intentionally single to focus on yourself? Explain your answer. *
Your answer
Activiites, hobbies, books you've read, events you attend *
Your answer
How would you rate your physical health? *
How would you rate your emotional health? *
How would you rate your mental health? *
How would you rate your financial health? *
How would you rate your spirtual health? *
Which option works best for a weekly group support video call? Select all that apply. *
Required
Your final step to become a member of the challenge is to reserve your spot in the program. Click howtogetovermyex.com now to save your spot as we review your application. *
A copy of your responses will be emailed to the address you provided.