Date Night & Anniversary Planning

Welcome to Amor Wellness Group! Thank you for taking the time to complete this form. Your answeres will help us plan according to your preference, personality, lifestyle, and what truly matters to you. Every detail you share is kept confidential and secure, and is used solely to provide you with the most effective support.

Tell us about you and your partner.

First Name *

Last Name *

Partner's First Name *

Email *

Phone *

Location *

Let's rekindle and rediscover dating.

Activities I want to share with my partner are:

What type of experiences make you feel most connected:

Describe the most magical date you’ve shared with your partner.

What kind of environment helps you open-up:

Would you consider going on dates outside your city?

If yes, what is your desired miles radius?

Are there any new activities or experiences you’ve been curious to try but haven’t explored yet?

Do you prefer dates that:

I have read and agree to the Terms and Conditions and Privacy Policy.
I consent to Amor Wellness Group collecting and using the information I provide for the purpose of responding to my inquiry, application, or participation in services, in accordance with the Privacy Policy.
I understand that submitting this form does not guarantee acceptance, participation, partnership, coaching services, referrals, employment, or wellness connections of any sort.
I certify that the information I have provided is accurate and complete to the best of my knowledge.
By submitting this form, I acknowledge that my electronic submission constitutes my agreement to these terms.

I accept the Terms and Conditions