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* 1. Please provide the following information:

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* 2. I have not been able to move on after my last relationship.

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* 3. I feel that:
(Choose all that apply.)

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* 4. I tell myself that I will be ready for a relationship when I pay off my credit cards, lose weight, finish my studies, get a promotion, or ____.

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* 5. When it comes to dating:
(Choose all that apply)

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* 6. I have created success in almost every aspect of my life, except in the area of love and relationships.

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* 7. I tend to attract men who are unavailable (e.g., married, separated or "getting divorced," in a relationship).

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* 8. I will only date men who meet specific criteria, such as:
(Choose all that apply.)

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* 9. I am not sure I believe that I will ever find the love I truly desire.

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* 10. Is there anything else you feel we should know?

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