VIVID Relationships: COMING SOON!

SINGLE AND STRUGGLING? TAKE CHARGE OF YOUR SEARCH FOR LASTING LOVE. Take the first step by completing the form below.

DR. VIVIANA IS HERE TO HELP!

VIVID Relationships: For Singles

Date*
MM slash DD slash YYYY
Your Name*
First Last
Your Age*
Your Gender*
Your Email*
Your Phone*
Your Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Upload a Current Unfiltered Face Picture*
Max. file size: 200 MB.
No filters needed.
Upload a Current Full-Body Picture*
Max. file size: 200 MB.
Current Relationship Status*
Have you ever been/Are you in therapy?*
What kind of dating help are you looking for?*
Please include what you're hoping to get out of your participation.
How did you hear about VIVID Relationships?*
Are you open to the idea of having your experience working with us documented?*
Saying "Yes" does not constitute consent. We will discuss this option prior to any recording.
By entering your FULL NAME in the space below you consent to having Dr. Viviana or a member of her team reach out to you regarding this project.*

You will also be added to her Email List and will have the option to unsubscribe should you ever want to.
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