Free Call Questionnaire
1. What's your relationship status?
Open Relationship (Alternative)
2. Where are you in a love life at this moment (in the last 3 months)?
Active online dating
Active face to face dating only
Not active dating
Dating with someone but it’s not serious
Being in a relationship but something important is missing
3. Where was the last time you’ve been in a committed relationship?
4. I am a person who:
Take action to live life more fully, passionately and joyfully
I'm fulfilled and comfortable where I am and rather passive
I’m not really sure what I am looking for
5. When it comes to how I make a decision in love life, I:
I need all the data/facts in front of me. I need proof before I jump in!
I tend to follow my heart and intuition
The fear of making the WRONG decision stops me from making any decision at all!
6. When it comes to giving and receiving in a relationship, what is your experience?
I like to receive. I need to feel loved before I can give love.
I give too much and sometimes it makes me resent the other person or feel that the relationship is not balanced.
It’s hard for me to give or receive.
7. Partners I date often tell me that I am:
Too controlling / too needy.
Too serious and not empathetic.
Hard to follow / too complex.
8. They also tell me that I am:
Strong and confident.
Beautiful and sexy.
Crazy and funny.
9. I tend to attract people who:
Aren’t committed to create life together
Take too much from me and can even be a bit manipulative.
Are not emotionally available.
10. When it comes to trusting a partner:
I trust my partner, but I know when I’m right and someone is wrong.
I trust too much sometimes. I am very open and quite often feel I get taken advantage of.
I don’t trust anyone! I’ve been hurt too many times.
11. The one pattern that keeps repeating in my love life is…
I tend to not trust people.
I tend to give too much and get too little.
Nothing ever feels deep and whole. It stays on the surface.
12. When it comes to my personal and professional goals:
I set them and achieve them. My growth is important, and I don’t let myself down.
I have a lot of things I dream of, but I get knock off by self-doubt or struggle by luck of time or other challenges.
I’m not sure I have any goals right now! Even if I did, I wouldn’t follow through or achieve them.
13. Do you take lead in a relationship?
Yes, I love taking charge and leading.
Sometimes, when it’s really required.
No really, I prefer when my partner take lead.
14. How easy is it for you to stay in your personal power and lose yourself in a relationship?
I always stay in my power, no matter what.
I stay in my power but when I’m in a committed relationship, I become more adaptable.
When I fall in love, I can lose myself from time to time
I stay in my power when I’m single, buy when I’m in love I completely loose myself.
15. Which personality type resonates with you the most?
Direct, taking action, result-orientated, assertive
Outgoing, talkative, emotional, entusiastic
Calm, stable, patient, supportive
Cautious, details-orientated, organized, analytical
16. When interacting with people are you?
bold and decisive
social and outgoing
peace-loving and kind
logical and intelligent
17. What are your biggest desires in your personal and love life?
18. What is it costing you to NOT achieve your goals? Be specific and reply in terms of your personal life: time, love, relationships, health and happiness.
19. Knowing my specialised programs range in price from AUD $5,000 down to AUD $1,000; how ready are you to invest in the radical growth of your personal and love life?
I am ready to invest in myself, and have cash set aside to do so.
I am motivated to grow, and will be using credit to invest in myself.
I'm not willing or able to invest in myself at this time and need other resources to help me.
20. Are you the decision maker in how you invest in yourself?
Yes, this is solely my decision to make.
No, I will need to consult it with my partner.
21. I promise to respect Lapis Evolution Advisor’s time by showing up for the time of this meeting
22. Is there anything else you want us to know?
Thank you taking the time to answer these questions. I can’t wait to speak with you. Kinga Staszalek - Lapis Evolution