Husband's First Name
Wife's First Name
Last Name
Husband's Email (Same as Used to Book a Call)
Wife's Email
Husband's Cell Phone Number
Wife's Cell Phone Number
How many years have you been married?
Did you live together before you were married? If so, for how long?
Briefly describe your family life. What does a typical weekday and weekend look like?
What are the top 3 dreams or goals for your marriage relationship?
What is "The Why?" behind what drives you to reach your top 3 goals?
What recurring obstacles or conflicts keep you from reaching your top 3 goals?
What areas in your marriage and family life are consistently out of balance? What do you believe is the root cause of this?
Husbands, on a scale of 1-10... (1 being I'm fine where we are today, and 10 being I'll do anything to reach our top 3 goals.) What number are you?
Wives, on a scale of 1-10... (1 being I'm fine where we are today, and 10 being I'll do anything to reach my top 3 goals.) What number are you?
Husbands in what areas of your relationship are you not feeling respected by your wife?
Wives in what areas of your relationship are you not feeling loved by your husband?
Husbands: Be 100% honest - what do you think is stopping you and your spouse from reaching your goals? (The more specific you are here the faster we'll get you clarity during our call together)
Wives: Be 100% honest - what do you think is stopping you and your spouse from reaching your goals? (The more specific you are here the faster we'll get you clarity during our call together)
What have you tried together to reach your top 3 goals, but it has not worked?
What is the cost of NOT taking action now to make your marriage better?
What else will it cost you?
And what else will it cost you?
How much is a happy marriage worth to you (and to your children)? Enter a daily dollar amount
How much credit card debt, including school loans, do you have right now?
What is your combined annual gross income?
Since our Marriage Coaching spots are limited, what makes you and your spouse different from other couples and why should we choose to work with you?
If your application is accepted, how soon can you get started?
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