Questionnaire


Hello, over there!

If you’re considering hiring Rose to consult with you as you Create Space for Love or Craft Your Epic Love Story please complete this questionnaire so we can get to know a bit more about you and your dreams, desires, and timeline.

Anything you write here is held in complete confidence, and when you click the ‘I’m ready to receive’ button, we will receive it securely.

Remember to schedule for your virtual tea chat.

Keep up the good work of doing something new and different.
Team Romance

Name:

Email:

I heard about this website by:

What is your #1 reason for requesting this virtual tea chat?*

Considering a specific program? Check below.*

Level 1 - Creating Space for LoveLevel 2 - Craft Your Epic Love StoryLevel 3 - Sparkle Glow & Shine Your True Signature VibrationLevel 4 - Claim Your Queendom Gathering callsFeng Shui ConsultingRomance & Relationship Coach (R&R)Holistic & Juicier Lifestyle GuidanceChinese Medicine - Five PhasesEssential OilsAll the aboveI'm not sure - let's talk

On a scale of 1-10, how prepared are you to work with Rose emotionally, mentally, financially and physically?*

What are my goals or desires I would like to achieve? *

How is your current situation getting in the way of creating more joy and flow in your life? What's going on? What's your challenge? *

Anything else we should know?