Love Breakthrough Intensive - Kavita Jhaveri, Relationship Coach

First Name *

Last Name *

Email *

Phone 1 *

Street Address 1 *

City *

State *

Postal Code *

Birthday *

Age *

Occupation *

What is your annual salary? (There is a large love & money connection which helps me make sense your unique position). *

Relationship Status *

Single

In a Relationship

Where are you feeling the most stuck in your love life? Please describe in detail. *

Instead of “stuck” where would you like to be? *

If you could change one thing about your behavior or thinking to have what you want in your love life what would that be? *

I talk a lot about how your parents are connected to your love life. Are your parents divorced or together? If one or both of your parents are deceased please indicate that as well. *

Have you been following me for a while? If so please tell me what has resonated with you. If you haven’t you can simply say no. *

How high of a priority is it for you to get what you want in love? Simply place in a number from 1 – 10. 10 being extremely important. *

Never finding the right person

Having children

Time is running out

Your not sure if he/she is the “one

Falling in love and not having them commit

You are sabotaging something good

You might lose them

Have you worked with a coach before? Also, please tell me if there is anything else you would like to tell me or ask me? *

Welcome. I am so happy you are here.