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The Friend Fix Application

The Dating Counselor

Application Form: The Friend Fix

First name

Last name

Birthday

Month

Day

Year

Email

Phone

Address

Position

Dating & Social Life

How would you describe your current dating life?

Not dating at all

Occasional dates

Actively dating

Burned out/ frustrated

What do you find most challenging about dating right now?

How confident do you feel interacting with the opposite sex in person?

Somewhat confident

Not very confident

Extremely anxious

Readiness & Fit

Why are you interested in joining Your New Friend Group?

What are you hoping to gain from this experience?

Are you willing to attend: (check all that apply)

2 singles events per month (with your group)

1 group dinner per month

1 monthly virtual group coaching call with The Dating Counselor

Participate for 4 months with 80% attendance

Mindset & Group Dynamics

Are you open to receiving honest, clear and kind feedback to improve your dating and social skills?

Yes

Somewhat

No

How do you typically handle social discomfort or awkward situations?

This program is focused on connection, not immediate pairing or pressure to date within the group. Are you comfortable with that?

Yes

No

If asked, could you pass a background check?

Yes

No

Logistics

Are you available evenings and weekends for events?

Yes

No

Sometimes

Are you willing to invest $100 per month for 4 months?

Yes

No

Is there anything else you want me to know about you before considering your application?

Thank you for applying!

If selected you'll be invited to a short call to ensure this is the right fit for you.

Spots are limited and groups are intentionally small to create the best possible experience.

Application

Application fee $15

Copy write 2026 @TheDatingCounselor

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