First Name Last Name Email Would you like Coach Camille to schedule a FREE 1-on-1 call with you? Yes No What attracted you to the Miracle Moments Video Series offer? How much of Miracle Moments have you watched? Please Select...Didn't Complete 1st Week1st Week2nd Week3–7 Weeks8–14 WeeksAll 15 Weeks How would you rate the value of the content you watched? Love it! Needs a little Improvement Needs a lot of Improvement Poor What did you like most about Miracle Moments Video Series and why? What did you like the least about Miracle Moments Video Series and why? Which topic did you appreciate the most? Please Select...Learn how to be confident when you’re meeting new menQuestions to ask a man you really likeImportant tips on what to say and what not to say on datesLearn and choose your personal boundaries before starting datingLearn how to set up and use online dating apps Which topic did you appreciate the least? Please Select...Learn how to be confident when you’re meeting new menQuestions to ask a man you really likeImportant tips on what to say and what not to say on datesLearn and choose your personal boundaries before starting datingLearn how to set up and use online dating apps Which topics do you want to learn the most about? Selection 1 of 3...Online datingnew relationship advicesex advicehow to healmarriage/long term relationshipflirtingfashioncompatibilitycommutationfighting and conflict resolutionlasting lovekeeping the spark alivecheatingself improvementdivorce Which topics do you want to learn the most about? Selection 2 of 3...Online datingnew relationship advicesex advicehow to healmarriage/long term relationshipflirtingfashioncompatibilitycommutationfighting and conflict resolutionlasting lovekeeping the spark alivecheatingself improvementdivorce Which topics do you want to learn the most about? Selection 3 of 3...Online datingnew relationship advicesex advicehow to healmarriage/long term relationshipflirtingfashioncompatibilitycommutationfighting and conflict resolutionlasting lovekeeping the spark alivecheatingself improvementdivorce How easy was it to access the video lessons after you signed up? Easy Needs a little Improvement Needs a lot of Improvement Difficult How would you rate the quality of videos in the course? Love it! Needs a little Improvement Needs a lot of Improvement Poor How practical and applicable was the video content? Very Some Not Much Not at All How would you rate the overall look and feel of the video course? Love it! Needs a little Improvement Needs a lot of Improvement Poor Overall, are you satisfied with your experience using the Miracle Moments Video Series? very satisfied satisfied dissatisfied very dissatisfied How likely are you to purchase any of the products? Very Likely Likely Maybe after Improvements Not likely What would need to be added to make you purchase the course? How much would you be willing to pay for the 15 week course or a similar course from a competitor? Please Select...$50-$99$100-$149$150-$249$250-$349$350+ What is your age range? Please Select...Below 2525-3031-3435-3940-4445-4950-5455-5960-6970+ What is your relationship status? Please Select...SingleMarriedDivorcedWidowedIn a Relationship Any additional comments or suggestions? Send
