Name * First Name Last Name Phone (###) ### #### Email * 1. What is your current relationship status? * 2. How often do you date (e.g., weekly, monthly, rarely)? * 3. What do you think is the biggest challenge you face in dating? * 4. On a scale of one to ten, how satisfied are you with your dating life? * 5. What is your primary goal in dating (e.g., casual fun, serious relationship)? * 6. How important is improving your dating life to you? (Scale of 1-10) * 7. What do you believe is holding you back from finding success in dating? * 8. Have you ever invested time or money into improving your dating skills (e.g., coaching, books, courses)? * 9. If you could improve one thing about your dating life today, what would it be? * 10. What motivated you to explore dating help now? * Thank you!