Where do you live? (city, state, country): *
Email: *
Occupation: *
How long have you known about me? * --- Select Choice --- Just recently Weeks Months Years
1. How would you describe your dating life right now? * --- Select Choice --- Nonexistent Inconsistent Some success, but not where I want to be I date regularly but still feel stuck I’m in a relationship but still want to improve myself
2. What age range are you in? * --- Select Choice --- 18–20 21–24 25–30 30+
3. What’s your top dating goal right now? * --- Select Choice --- Get more matches/attention Get better at talking to women Overcome fear around approaching Build confidence Have better relationships Improve myself overall Overcome a breakup
4.2 Confidence Gap (not feeling good enough, overthinking) * --- Select Choice --- 1 2 3 4 5 6 7 8 9 10
4.3 Mixed Signals (can’t tell if she’s interested) * --- Select Choice --- 1 2 3 4 5 6 7 8 9 10
4.4 Social Skills / Flirting (awkward, bad at conversation) * --- Select Choice --- 1 2 3 4 5 6 7 8 9 10
4.5 Swiping Overwhelm (burned out on dating apps) * --- Select Choice --- 1 2 3 4 5 6 7 8 9 10
4.6 Commitment Avoidance (fear of something serious) * --- Select Choice --- 1 2 3 4 5 6 7 8 9 10
4.7 Guardedness (hard to open up, be honest, or trust) * --- Select Choice --- 1 2 3 4 5 6 7 8 9 10
4.8 Lack of Sexual Confidence * --- Select Choice --- 1 2 3 4 5 6 7 8 9 10
4.9 No Direction (lack of purpose / mission in life) * --- Select Choice --- 1 2 3 4 5 6 7 8 9 10
5. What’s the #1 thing you feel is holding you back in dating right now? *
6. How long have you been struggling with this? * --- Select Choice --- Less than 6 months 6–12 months 1–2 years 2+ years My whole life
7. What have you already tried to fix this? *
8. Why do you think this is still a struggle for you? *
9. If you could fix ONE area in the next 30 days, what would it be? *
10. How would your dating life look if everything were running perfectly right now? *
12.1 If YES: What did you invest and what did you like or not like?
12.2 If NO: What usually stops you from investing in improving your dating life?
13. If you found a program that actually solved your biggest problem, what results would you expect to walk away with? *
15. What investment range feels reasonable if you KNEW it would fix your biggest dating struggle? * --- Select Choice --- $0–$50 $50–$100 $100–$200 $200–$500 $500–$1,000 $1,000+
16. If I created weekly content around the areas you need most, what topics do you want? *
17. Anything else you want me to know about your situation?
