Thank you for signing up for a Clarity Call.

Please complete this Intake Form:

First Name *

Last Name *

Contact Details

Email *

Phone *

By submitting, I agree to receive calls, emails, and text messages from Delight Your Marriage, LLC regarding my assessment results, marriage resources, programs, services, and related offers. Calls or texts may be made using automated technology or prerecorded/artificial voice. Consent is not a condition of purchase. Message frequency varies. Message and data rates may apply. Reply STOP to opt out of texts at any time. See our Terms and Privacy Policy.

Marriage Details

What are the main reasons you signed up for this Clarity Call? *

How long have you been married? *

Current Marital Health

On a scale of 1 to 10, how dissatisfied are with you with the state of your marriage or intimacy? (1=Very Unsatisfied 10=Very Satisfied) *

Where my marriage is now has negative affects on these aspects of my life (Select all that apply). *

My levels of peace or worry

My children's self-esteem & feelings of love and stability

Our finances or financial stress

My career

My ministry or the work God wants me to do

My level of loneliness or anger

My dissatisfaction with sex

My health--mentally and physically

Season Discernments

Please describe your family's life circumstances:

1-Occupations: a-Husband, b-Wife

2-Children: a-Ages, b-Which children are present in the home?

3-Major time commitments for you or your spouse? (Please be descriptive here).

In some situations, it may not be advisable for your spouse to be informed right away.

If your spouse is already aware, how open and willing are they to make changes themselves?

If your spouse is not yet aware, what are the key reasons you have chosen not to share this with them at this time? Do you believe they would support your involvement in this process? Please share your thoughts in detail.

Timing Considerations

How ready are you to do whatever it takes to change this marriage or intimacy? (1=not committed, 10=totally committed) *

Have you tried to change this before? How? *

Why are you looking to change this now -- instead of later or a different season of your life? *

Personal Commitment

How long have you been struggling and how long can you keep struggling? *

Is investing in your marriage important to you? *

Yes

How did you find out about this Clarity Call? *

Is there anything else you'd like your Clarity Advisor to know?