The Relationship Bro Ex Back Application

Please Complete This Form!
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
What is your age?*
What is your Partner/Ex's age?*
What is your occupation?*
What is your Partner/Ex's occupation?*
What kind of relationship did you have?*

DatingMarriedDivorcedSeparated
Do you have children together?*

No Children1-2 Children3-4 Children5+ Children
How long was the relationship?*

Less than 6 monthsMore than 6 months1 year +
How was the chemistry with your Partner/Ex?*
(Mentally, Physically, Emotionally, Sexually, Spiritually)
Still together or when did the breakup happen?*

Less than 2 weeks ago1 Month ago3 months ago6 months ago1 year+Still together
Did you live together?*

YesNo
Is there a history of domestic violence, restraining orders, or suicidal tendencies?*

YesNo
Is your Partner/Ex answering any communication at this point?*

YesNo
Has your Partner/Ex blocked you from any social media?*

YesNo
When was the last actual contact with your Partner/Ex?*

Within a weekMore than a weekMore than a monthMore than 6 months
If your Partner/Ex's best friend asked them, "Why did the breakup happen?" What would your Ex say? *
(Be Honest! This is the most important question.)
Does your Partner/Ex know you want them back?*

YesNo
What did you want to change in your relationship? And what were the challenges that are preventing you from making those changes?*
(Be specific.)
What did you want out of your relationship that you didn't have?*
(How do you want it to be when you get your Ex back?)
What do you currently feel is the biggest issue that you MUST address within your life?*

I am going through a breakup/separation/divorce and I need to heal.I am seeking direction on how to LEAD my life and family.I need to increase my confidence and reduce my anxiety so I can make better decisions.I just don't know...I'm completely lost in life right now.
What area of your life creates the MOST frustration for you?*

MoneyRelationshipParentingHealthPersonal FulfillmentOther
If you don't figure out how to resolve your problems as soon as possible, what do you stand to lose?*
How committed are you to resolving these issues NOW?*

This is more important to me than anything else in the world!I have other commitments that are a higher priority right now.I'm really just exploring so I'm fearful to commit to anything.I'm only committed if my Ex commits first.
Why are you currently at this level of commitment?*
To serve you best, what is your expected outcome of our call?*
(Be realistic.)
If an offer to join the RelationshipBro program was made to you, what is your level of commitment to join?*

No interest at all.I'm ready to join during the call.I need to hear more about the program before I make that decision.I have never even heard of the Relationship Bro program.
How much are you willing to invest in your self-improvement and fixing your relationship?*

Nothing I'm completely broke and only want free stuff to help$600-$1.2k (interested in a 1-on-1 call to help me understand what to do and material on how to do it myself)$5k (interested in 1-on-1 coaching with small group coaching on a continuous basis for a year)$10k-$50k (I want to apply for the 1-on-1 coaching mentorship, done for you service, and 24/7 access so I'm never trying to figure it out alone) *Limited Spots*
This is your first test to being a person of integrity. Do you agree to show up at the time you schedule?*

YesNo
What else, if anything, would you like me to know when considering your application?*
(What else do I need to know about you?)
Saving your relationship will require an investment no matter what. Even though the financial aspect is the easiest obstacle to overcome, it is often the obstacle that keeps people from taking action and therefore keeps them stuck in their pain.
If we agree that we can work together to achieve your desired outcome, are you open to discussing how you can eliminate this limiting belief so you can FINALLY break free from the pain that you're feeling?*

No, I'm NOT open to that. I'm broke, have no credit, no desire to figure out a way to be resourceful. I guess this isn't for me.Yes, I'm willing to have that discussion in an effort to become the BEST version of myself and to save my failing relationship.
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