Full Name *

Phone *

Email *

Who is completing this application? *

How long have you been married? *

Do you have children? *

Are both spouses aware that this application is being submitted? *

How willing do you believe your spouse is to participate? *

How would you currently describe your marriage? *

What are the three biggest challenges in your marriage? *

If this journey worked beautifully, what would be different in your marriage eight weeks from now? *

Is there currently any physical violence, fear for personal safety, coercive control or active abuse in the relationship? *

Is either spouse currently experiencing a serious mental-health crisis, active addiction or suicidal thoughts? *

The complete investment for The Marriage Rebuild Journey™ is AUD $3,197. We also offer a flexible session-by-session coaching pathway. Which option feels most suitable for you at this stage? *