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Dating and Intimate Relationship Coaching Assessment

Please fill out the form below so we can learn more about you in order to get you started in the correct program. Once you have submitted the form we will reach out to regarding the next step.

First Name

Last Name

Phone Number

Do We Have Your Permission To Text This Number?

Yes No

City

State

Your Age

19-25 26-35 36-45 46-55 56 or older

How did you hear about the services of Relationship Avenues, LLC?

An email correspondence I heard you speak At a live networking event At a zoom event Someone told you about us Other

Please fill out how you heard about us if you answered 'Other'.

Have you ever taken anyone of the following?

Self-development Courses Dating Courses Communication Dynamics For Couples (Or Close To It) Love and Relationship Builder Course (Or Close To It) Personal Assessment Course No

Please briefly describe courses or coaching you marked as taken.

Why are you interested in taking one of our courses or coaching/consulting services? What are three things you are hoping to accomplish?

Are you happy with your current career choice? Or do you believe there is MORE out there for YOU? Do you know what it is? Briefly explain

Are you…

Married LTP (Live Together Person) In a relationship (Not Living Together) Dating Single Have Children

Ages of children

Tell me about your personally? (The more you can share, the better I can guide and support you)

Anyting else you would like to share?

Ready to Transform Your Relationships?

Contact Us

Kevin@RelationshipAvenues.com
(407) 900-1398
3800 Greenfield Rd. Suite 1562
Dearborn, MI 48120

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