PowerfuLove's Fulfilled Program Application

Thanks for your interest in our Fulfilled Program! To better understand whether you'd be a good fit, we'd like to learn a bit more about you, your marriage, and what you'd like to achieve in this program. If this application suggests we can help, we will confirm our call. If not, we'll reach out to cancel and suggest other resources if we have them.

First Name *

Last Name

Pronouns

Phone *

Email *

Spouse's Name

To invite partner, click "Add Guest" at the bottom of form

How long have you been together? Married? *

Overall, how fulfilling has your marriage been over the last 3 months?

What do you think has been getting in the way of you having more of what you desire and deserve in your marriage?

Are you or your partner currently struggling with any of the following? (Check all that apply) *

Why are you desiring to make these improvements NOW? *

Why us? Why do you believe that we may be the ones to help you? *

How "WORTH IT" for you is it to invest in growing, deepening, and strengthening your relationship? *

How committed are YOU to doing your part to co-create a relationship that fulfills and delights you? *

100% Committed! I'm ALL IN!

I'm definitely committed and willing to work on us

I'm open to it

I'm on the fence

How committed is YOUR SPOUSE to doing their part to co-create a relationship that delights and fulfills them, too? (if you can't ask them, take a guess) Keep in mind, it is NOT necessary for your spouse to participate to experience the changes/improvements you desire! *

100% Committed! They're ALL IN!

They're definitely committed and willing to work on us

They're open to it

They're on the fence

I have no clue at this point

Would your spouse, at a minimum, be willing to have a private conversation with us to share his/her/their side of the relationship story?

PowerfuLove's "Fulfilled" program requires an investment of $6,000 paid upfront in full to work with you. There are opportunities for us to work with you AND your spouse for an additional investment of $3,000. Our work is NOT THERAPY, and we do not accept insurance.

Understanding the above... if we make an invitation to join Fulfilled, are you prepared to invest financially AND energetically in this program so that you can experience the fulfillment in your marriage that you desire and deserve? *

Yes

Possibly

Is there anything else we should know to help us understand if and how we might be able to help you?

Your next step is to book a Decision call, where we will decide whether to invite you into this program and, if we do, support you in deciding whether moving forward with Fulfilled is the right move for YOU. Respectfully, please don't ghost us on this call. These calls are a big investment of our time, energy, and love. If you no show for the call, you will not be able to reschedule.

Got it- I'll make sure to let you know if we decide to cancel or need to change

That's cool. I don't really want to improve my relationship anyway. (wink)

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