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First Name
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Last Name
Phone
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Email
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What is your age range?
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25 to 34
35 to 40
41 to 44
45+
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Are you currently on any antidepressant medication?
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No
Yes
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Are you in a relationship right now?
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No
Yes
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How long ago were you in a meaningful relationship that made your heart sing?
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a few months
a year
2 years
5 years
never
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What is your biggest struggle when it comes to dating and relationships?
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How committed are you to solving this problem in your life?
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I am 100% committed. I can no longer tolerate my current situation and change must start today.
I’m committed, but a little nervous. But with the right support, I KNOW I can do this!
I don’t really want change. It’s not a real priority for me right now.
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Please describe below what you have done already to try and change this.
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If someone advised me to get out of my comfort zone and invest in myself to attract my soulmate, I would...
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Know it's what anyone serious about being in a relationship would do.
Avoid it at all costs because I don't want to have to change.
Would be a little intimidated, yet with a proven system I would do it because I'm serious about meeting my soulmate.
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What is your ideal scenario for your love life in 6 months? Use your heart and imagination here. Have some fun with your answer. (Single word responses will result in call cancelation)
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Have you seen the masterclass on 5 shifts to attract your soulmate?
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Yes
No
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What really spoke to you about the masterclass?
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A member of our coaching team will meet you on Zoom at the time you chose. Please commit to your appointment by typing this sentence in the box below: "Yes, I promise."
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Are you in Lucy's free Facebook community, Ignite Your Queen Attract Your Soulmate? *If not, be sure to click the link in your confirmation email to join
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Yes
No
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On a scale of 1 to Beyonce, how awesome are you?
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Finally, how did you hear about us? If a friend referred you, please let us know who it was so we can celebrate them.
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