Real Conversation Relationship Dynamics Application

Before completing this form, please read the Getting Started section by clicking the tab in the upper right of this page.  I want to make certain we are likely to be the right fit for a client – consultant working relationship.   This is for you and your time, as well as for me.

Please answer the following questions completely.  The greater understanding I have about your situation, the more likely it is I will be able to determine if we are a fit to work together.  Your detailed answers are meant to help clarify for me how what I do can be applied to what you need.

Should I feel we might be a match, you will be contacted to schedule a Real Conversation at a mutually agreeable time.    If you are scheduled for this call (value $1500US), it will be delivered to you for no investment.

    1. Your Name (required)

    2. Your Email (required)

    3. Please tell me who referred you so I may thank them.

    4. In what country are you located?

    5. What do you do for a living? Does your work impact your relationships and/or your state of well-being?

    6. For what specific Relationship Dynamic(s) do you want my assistance? (romantic or love relationship, divorce or separation, business, professional partnership, business associate, business team, self, parent, child, sibling, soon to be ex, any other significant person or meaningful friendship).

    7. Describe the specific challenge(s) you are dealing with or facing. Please provide details.

    8. If we could attain your ultimate result(s), what would that be? Please be specific.

    9. What have you done in the past to help this challenge? How much time, energy and financial resources have you already invested?

    10. On a scale of 1-10, in which 10 is ‘I want help now’, and 1 is ‘I’m okay’, what number is appropriate for how important it is to you to solve/heal/shift your issue(s)? Add anything you feel is relevant to your answer.

    11. If following your Real Conversation we were to discover you are a candidate for my VIP services, is there anything in the way of you taking action now? (ie. time, energy, financial resources, mental focus, commitment, etc.) If yes, what?

    12. Please provide your time zone and the best days and times you would be available for a Real Conversation.