First Name *

Last Name

Email *

Phone *

Choose the biggest issue you face currently *

Communication Issues
I had (or are still having) one or more affairs
They had (or are still having) one or more affairs
Stop my divorce
Rebuild Trust
Crisis - Not infidelity
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Is your partner willing to work on things with you? *

Yes
No
Not sure
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Relationship Status *

Married
Separated
Divorced
Engaged
Dating
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How familiar are you with our company? *

I'm a big fan, been following you for months or more, and have listened to multiple podcast episodes
I've listened to a 1 or more podcast episodes but just found you recently
I just heard about you now, have not listened to the podcast
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Are you able and willing to invest in yourself and/or relationship?

Yes - I have cash or credit to invest in myself
No - I don't have cash or credit to invest in myself
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I agree to terms & conditions provided by the company. By providing my phone number, I agree to receive text messages from the business. I can opt-out anytime. Your information remains confidential.