Relationship Help Survey

Relationship Transformation Strategy Session Request

Please, fill out the form below
First Name*
Gender*
Email Address*
Phone Number (Please, note that we call ONLY the US, Europe and Australia)*
Have you had a difficult relationship story so far?*

YESNO
Would you like your relationship issues to be gone as soon as possible?*

YESNO
If yes, please explain the major issue(s) of your relationship situation (a paragraph or two).*
ONLY 2 or 3 words is not acceptable. Please, explain in at least one paragraph.
Are you ready to take the necessary actions to transform your relationship pattern?*

YESNO
What makes your situation deserving of a courtesy strategy with me?*
We are very busy, so please, note that if we feel (based on your answers) that you are not very motivated at this time, we won't be calling you. If you are motivated, however, it will be our pleasure to speak with you.

~Sylviane Nuccio, CPC
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Relationship Transformation Strategy Session Request