Love Breakthrough Sessions with Bex
Thank you for applying for a Love Breakthrough Session with Bex by filling out this form.

Please answer the questions with as much openness and honesty as you can.

After you click "submit", the next page will show a link to book time with Bex. Go ahead and reserve time on the calendar; in the meantime, we will review your application and confirm your booked time if you qualify.  
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What do you want to experience in your love life right now? *
Include any / all relevant details about the kind of relationship you want, whether that be internally (your relationship with yourself) or externally (your relationship with a romantic partner). What's the dream?
What’s not working? What issues or obstacles do you run into? What keeps happening instead of the love you want? *
Include any / all relevant details that detract from your efforts: including internal: feelings, emotions, thought loops, patterns you see but can not break; or external: issues meeting quality candidates, attraction patterns that you can't break, additional circumstantial insecurities including: housing, income, employment, health
What is working? Describe how you are supported and primed to create this vision NOW. *
Include any / all relevant details that support you for doing inner work: stability with employment, housing, income; other mentors, guides, healers or professionals; Loving family, healthy hobbies, time / money freedom etc.
How long have you been feeling stuck? *
How does it make you feel, being in the gap between where you are now and what you desire? *
How do you talk to your girlfriends about this? Name all the things. Be as descriptive as possible.
What else have you done to address the situation? (therapy, coaching , self-help books, groups, retreats, friend /family guidance etc.) *
List everything you can remember / think of
Is there anything more pressing that needs to be addressed in your life at the moment or is your love life the top priority? *
Did you catch the free webinar, "The Top 3 Ways Strong Women get Stuck in Love?" *
If your answer is NO,  you are invited to watch the webinar on demand here: http://www.bexburton.com/
If I could custom-build a training for you, what do you want to learn most, what skills do you desire, what do you feel you need most from me? *
Tell us why Bex is the Love & Relationship Coach you want to work with. *
If at the end of our call, we all decide you are a fit for the Your Majesty Private Coaching with Bex, we will invite you to become a client. Are you prepared to commit? *
How did you find Bex Burton Coaching? *
If you were referred by a friend, please use the "other" box to share their first and last name so I can personally thank them!
Name *
Your Age: *
Your Email Address: *
Your Phone Number *
Your current City, State *
Please include your COUNTRY if you reside OUTSIDE the USA.
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