Debra's New Love Survey

Introduction

Full Name:

City/State/Country

Age Range

Email Address: *

Section 1

When you think of falling in love with the "one," what do you get excited about?

What overall big dreams do you have for your life?

What do you have to offer a romantic partner that is unique and desirable?

Name the top five traits you are looking for in a mate.

What are you proud of about yourself and your life in the past five years?

Do you have any other goals in life besides meeting your life partner? *

Are you looking to find anyone to love or are you willing to be patient and attract someone incredible? Anyone will do, I am done with being singleI am willing to wait for an amazing man and lasting relationship

Additional comments:

Section 2

What is your long-term vision for what you are looking for in a relationship (children, marriage, living together, etc.)?

What are your goals for your inner world (such as increase confidence, less stress, be more at peace, find my passion, spirituality, etc.)

Why is having a relationship important to you, what would happen if you didn't reach your goals?

If you had three wishes to be fulfilled in the next 12 months, what would they be?

If you could change three things about your relationship experience, what would they be?

What do you believe are the biggest obstacles in your way of finding true love?

If you could change three things about your inner life what would they be?

Section 4

How do you rate yourself as having these qualities?

Any additional comments:

Are you willing to make changes to both your internal and external worlds to bring about the relationship you desire?

Is there something missing that you feel is important for your success in finding true love?

Do you have an internal "daily practice" (for example: silence, stillness, nurturing, laughter, meditation, affirmation, visualization, journaling, etc)? How much time do you spend on it each day and what do you do?

Section 5

What do you think is more important?

What area do you think you are stronger?

Who are your heros, heroines or role models?

Have you ever paid to have a coach or mentor for your love life?

If you haven't paid for a mentor or coach in the past, what were your reasons?

How much have you invested in personal growth or relationship workshop, books, audios in the past 12 months?

What is your impression of coaching/mentoring? (check all that apply) It sounds like therapy and a lot of painful work
It sounds like therapy and I already had therapy
I know it isn't about "fixing" me, but allowing me to be my best just as I am
I never thought of it for my love life
I have used coaching before and it didn't work for me
I am not sure what coaching is
I am excited about the possibility of love coaching

If you could have someone to be your coach/mentor through the process of attracting your ideal relationship and having a more joyful experience in all aspects of your life, how much time would you be willing to invest in yourself to make this happen?

How would you feel about a recorded phone coaching session that included guided visualizations to help you attract love easier and faster than regular coaching? -Check all that apply. Sounds great, I love using visualizations
Not sure if I can visualize
Not sure if I want my personal session recorded
Not sure if I can relax enough for a guided visualization over the phone
Prefer just to have the coaching only

Select the top three criteria that are important for you in your coaching experience. Evening & Weekend Hours
Recorded Sessions
Email Coaching in-between sessions
Visualizations/ Hypnosis on the Call
Feeling like the coach can relate to me
No long-term commitment
Group Coaching Calls with other Singles
Private community to connect with other singles

Have you read LET LOVE IN?

How much would you be willing to pay for a coaching program to help you reach your goals in life? (Note: The higher the amount, the more value provided in the program.)

Besides financial considerations, what else would stop you from joining a Love Mentor program to give you the tools you need to attract your true love? *

Is there anything else you would like to share?

Thank you for completing the survey, simply fill out the following and select "NEXT PAGE" and you will be taken to a page to schedule your free 30-minute coaching session with me!

Thank you for your time!

Debra Berndt