Pre-Diagnostic Questionnaire

Name *

E-Mail *

Phone Number: *

1. What is your current relationship status? *

2. When was your last committed relationship? *

3. How long did the last relationship last? *

4. What issues are you facing with dating men? *

5. What do you think is the reason you haven’t been able to meet the right partner? *

6. On a scale of 1 (low) – 10 (high) how would you rate your love life? *

7. On a scale of 1 (low) – 10 (high) how would you rate your dating skills? *

8. On a scale of 1 (low) – 10 (high) how would you rate communication skills with men? *

9. On a scale of 1 (low) – 10 (high) how ready are you for a committed relationship? *

10. On a scale of 1 (low) – 10 (high) how committed are you to your success in finding your soulmate? *

11. Are you ready to invest into improving your love life? *