Marriage Breakthrough Session
To sign up for your free 45- minute marriage coaching call, complete this survey as completely and honestly as you can. It will give us some information ahead of time so we can make the most of our time together.

After receiving your responses, we will contact you at the email you supplied and set up a time to meet.
Sign in to Google to save your progress. Learn more
Email *
Your Name *
What is the main problem in your marriage that led you to reach out to us? *
How long have you been married? *
How long did you date before you were married? *
What initially attracted you to your partner? *
On a scale of 1-10, describe your level of commitment to your relationship. *
On a scale of 1-10, describe how much you love your partner. *
List three things you admire about your spouse. *
In what area of your marriage would you like to see the greatest change? *
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms