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Coaching Application
Contact Information
First Name
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Last Name
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Email
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Phone
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Age
Gender
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Female
Male
Relationship Status
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Single
In Relationship
Married
Divorced
Widowed
Questions
How do you feel when you are not in relationship?
Have you been hurt before? If so, what are you afraid of that perhaps stops you being in relationship?
What does DATING mean to you? What, if anything, scares you about dating? What stops you from dating?
What words describe how you feel when contemplating a first date? Safe? Excited? Nervous? Judging?
What support would really work for you? What do you want to happen for you?
What is your intention for relationship and romance? What is your dream?
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