THIS FORM MUST BE FILLED OUT FOR THE APPT

First Name *

Last Name *

Please select your calling preference *

Zoom ID *

Your phone number *

Current relationship status and living situation *

Have you taken any professional steps to improve your relationship like counseling *

What would you like to see the outcome of this relationship be? *

What do you think your biggest obstacle is that is stopping you from having the relationship you desire *

How willing and able are you to invest financially in having the relationship you deserve? *

What makes you different from the other applicants, and why should we should choose to work with you? *

If you're accepted, how soon can you get started? *