Анкета

First Name

Email Address

Which best describes your current relationship situation?

Single and dating

Single and not dating

In a relationship, but uncertain

Married, but emotionally disconnected

Recently ended a relationship

In your relationships, which of these patterns feels most familiar to you? (Multiple answers allowed)

Different men, similar disappointments
I tend to give more than I receive
I’m drawn to emotionally unavailable or distant men
Things start strong, then slowly fade
I’m not entirely sure - I just know something isn’t working

How is this affecting you emotionally right now? (Multiple answers allowed)

I feel guarded or cautious
I feel lonely, even when I’m with someone
I doubt my judgment in choosing partners
I feel tired of starting over
I try not to think about it, but it’s always there

At this stage of your life, what feels most important to you in a relationship? (Multiple answers allowed)

Not wasting time anymore
Having a real partner, not uncertainty
Emotional peace and safety
Sharing life with someone
Being hopeful, but much more selective now

What have you already tried in order to change this pattern? (Multiple answers allowed)

Therapy
Coaching, courses, or workshops
Books, podcasts, or online videos
Taking breaks from dating
“Working on myself” in different ways
I’ve tried many things, but nothing truly shifted

Do you feel this is something you can fully resolve on your own? (Single choice)

Yes, I just haven’t figured out how yet

Maybe - but I keep circling the same place

No - it feels like something deeper is involved

I’m not sure, but I’m open to guidance

If this pattern (or patterns) were no longer running your love life, what would you want instead?

If you felt supported in the right way, how open would you be to doing deeper, focused work to change this? (Single choice)

Very open - I feel ready

Open, but cautious

Curious, but not sure yet

Not ready at this time

If you and I both feel there’s a fit after the Reset Call, are you open to investing between $999–$4,999 to resolve this pattern at the root? (Not a commitment - this just helps me understand fit.)

Yes

Possibly

No

Is there anything you feel is important for me to understand about your situation before we speak?

Thank you for taking the time to reflect and share. I look forward to our conversation.

During our free, private call, we’ll look at the pattern that may be keeping you stuck in your love life, and I’ll explain what next steps could look like for you - if you choose to explore them.