Are you a man? We only work with men.

Yes

How long have you been with your spouse *

Are children involved *

Yes

What is the main area you want help with? *

My wife has left me and I want to win her back.

My wife is threatening to leave me and I need to take action.

I want to become a better father and husband for my family.

I'm doing this for me, so I can be happier.

What's not working right now and what do you want to fix? (Describe) *

Full Name *

Email *

Phone *

Have you attended counceling/therapy before? *

Yes

What have you tried previously to solve these problems? *

What country are you based in? *

United States

Australia

Other

Full transparency…Should our services be a good fit for you, we offer payment plans starting at $300 per month. Which option best describes your needs? *

$300 per month is outside my budget.

$300 per month is not a problem.

Have you previously invested, or would you consider investing, in a solution to resolve your challenges and save your marriage? *

I have invested time/money/energy into fixing my marriage

I am open to investing time/money/energy into fixing my marriage

I have no financial resources to invest in myself

How soon are you looking to get help? *

I need help now and I'm ready to take action

Within the next 3 months

Not sure

What is your current employment status? *

Unemployed

Part-time employment

Full-time employment

Self-Employed

Business Owner

Retired

Is there anything else you think we should know about your situation that could help us, help you?