What are your preferred pronouns?
*
She/Her/Hers
He/Him/Hers
They/Them/Theirs
Prefer Not to Say
Not Sure
Email
*
Phone
(###)
###
####
What coaching program interests you?
*
Dating Decoded™ 1:1 Coaching Program
Relationship Renewed™ 1:1 Coaching Program
Love Life Reset 1:1 Strategy Session
What best describes you?
*
Straight
Gay/Lesbian
Bisexual
Queer
Pansexual
Demisexual
Asexual
Aromantic
Open
Unsure/Questioning
Other
No Label
Rather Not Say
What is your current relationship status?
*
Single (Not Dating)
Single (Dating)
Monogamous relationship (Not Married)
Married (Monogamous)
Married (Non-Monogamous)
At a crossroads in my relationship
Open Relationship
Polyamorous relationship
Recently Divorced
Recently broken up
I'm unsure.
Other
Rather not Say
What are the biggest challenges you’re facing in your relationship (or dating life) right now?
*
Is there anything else you'd like me to know about you or your relationship or love life?
*
When would you like to start this coaching program?
*
I'm ready now!
Within the next 6 months.
I'm not sure. I'm still looking at options.
What outcomes are you hoping to achieve from working with me?
*
Are you ready to invest in coaching to get the relationship you want?
*
Yes
No
I'm not sure.
How did you hear about Coach Muffie?
*
TikTok
Instagram
Facebook/Meta
Youtube
Podcast
Friend/Coach/Therapist
Google/Search Engine
Thank you!
Your application has been received and will be reviewed soon. If it’s a good fit, an email will be sent with the next steps, including how to schedule a consultation call.
Be sure to check your inbox (and spam folder) for updates. If any immediate questions come up, feel free to reach out at muffie@coachmuffie.com.
You're one step closer to getting the relationship you’ve dreamed about!
