First Name:
Last Name:
Email Address:
Telephone Number:
What Is The Best Description Of Your Current Relationship Status?
Which Option Below Best Describes Your Current Relationship Situation?
What Would You Say Are The Main Challenges In Your Marriage?
What Would Your Partner Say Are The Main Challenges In Your Marriage?
What Actions Have You Already Taken To Resolve Your Challenges (Please Select All That Apply)?
What Would You Say Are Your Main Objectives Or Outcomes That You Would Like To Achieve In The Next 90-120 Days?
What Do You Feel You Most Need Our Help With Right Now?
If You Are Accepted To Work With Us, Do You Have The Financial Resources To Invest In Your Marriage And Life?
Finally, where are you on the scale of 1-10? (1 Being: "I'm not very serious about improving my relationship and life right now" and 10 Being: "I'll do WHATEVER it takes to improve my life and relationship."
Is There Any Additional Information About Your Situation That Would Help Us To Prepare For Our Call?
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