Reboot Consultation Application
Hey brother it's Coach Frank! Please fill the application out in as much detail as possible and if approved don't forget to book a time to chat with me 1-on-1 after you finish answering the questions so we can decide if working together is a good fit. Sound good?
Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Age?
*
Occupation
*
What do you do for a living?
Married or single?
*
Married
Single
Can you make decisions about these situations WITHOUT your wife/spouse's input?
*
Yes
No
N/A
Please briefly describe your problem with porn, masturbation, or sex.
*
Please describe how you would like your life to improve by changing this behavior.
*
On a scale of 1-10, how committed are you to overcome this?
*
Why is NOW the time? What happens if you don't?
*
Which one best describes you? (Please only select one) *
I have the financial resources to invest into coaching to end my porn use
I have access to the financial resources to invest into coaching to end my porn use
I do not have the financial resources to invest into myself and end my addiction to porn
If your application is accepted you will be prompted to book a 1-on-1 call with Coach Frank. Nobody likes to have their time wasted. No shows are EXTREMELY RUDE and I know you're better than that. If you choose to book a call on the next page, do you promise you will show up on time and ready? (This means not driving or doing anything else)This question is required. *
Yes, I promise I will be ready for the call on time. I respect your time as well as my own time.
No, I'm just filling out this application because I have nothing better to do, I love wasting my own time, and I also want to waste some of your time.
Submit
Should be Empty: