Turnaround Marriage - Breakthrough Session Application

Your Name* This field is required.

First Name

Last Name

Your Spouse's Name* This field is required.

First Name

Last Name

Ages (Your's, Spouse's)* This field is required.

Your Email* This field is required.

Your Phone Number* This field is required.(We will call you this number and text you ahead of time to remind you & give you our number. Message & data rates apply. )

Area Code

Phone Number

Are you legally married?* This field is required.

Yes

How long have you been married?* This field is required.

Have either of you been previously married?* This field is required.

No (Neither of Us)

Yes (Both)

Yes (Husband)

Yes (Wife)

Are you presently separated?

YESNO

How long have you been separated?

How many children do you have? What are their ages?* This field is required.

Do you have a present church and if so what type?* This field is required.(Baptist, Presbyterian, Independant, Lutheran, Catholic, Etc.)

What is your occupation (and/or your spouse's)?* This field is required.

EVALUATE your marriage in the following AREAS:* This field is required.1 = HUGE CONCERN, 5 = NO PROBLEMS (scroll down to see all areas to continue)

How long have you been STRUGGLING in your marriage (or with these problems)?* This field is required.

ADDITIONAL COMMENTS ON ANY OF THE ABOVE AREAS:

Do either you or your spouse struggle with untreated substance abuse?* This field is required.(Abuse of prescription drugs, alcohol, marijuana, illegal drugs, etc)

YESNO

Have you been sober at least 30 days?* This field is required.

YESNO

What have you tried in the past to help improve your marriage? What are you doing right now to fix things?Select All That Apply

Prayer

Talking with Pastor / Leadership

Talking to Friends

Books

Counseling

Therapy

Coaching

Watching Videos

Retreats

Other

How much have you invested (cumulatively) trying to solve these challenges?(Take a moment to add up - counseling, therapy, retreats, intensives, books, seminars, coaching, etc)

$0-$1,000

$1,000-$5,000

$5,000-$10,000

$10,000+

What is likely to happen if things don’t change in your marriage relationship?(Check ALL that apply)

Loneliness & heartbreak

Suffering for your children

Impact on Physical Health

Impact on Emotional & Mental Health

Loss of Relationships & Connection

Loss of Career or Business

Impact on Finances

Separation

Divorce

Other

How committed are you to your marriage on a scale of 1-10?* This field is required.1 = Not Committed at All, 10 = Totally Committed

What is the biggest OBSTACLE to having the marriage that you want?* This field is required.

If you could describe your dream marriage in 5-10 years, what would that look like?* This field is required.

Will you BOTH be on the call?* This field is required.BOTH are NECESSARY if BOTH PARTIES ARE WILLING to work on the marriage. If you are the only one willing to get help, please proceed. We need all of the DECISION MAKERS on the phone.

MY SPOUSE AND I will BOTH be on the call

I am fighting for my marriage ALONE (right now)

I need to reschedule to get BOTH of us on the call

If someone asked me to invest 30-45 minutes a day to save my marriage, I would...* This field is required.

Know it's what any serious Christian would do to heal / improve their marriage.

Would be a little unsure, but with a proven system, I would do it because I am serious about solving these problems.

Avoid it all costs because I am too busy.

This best describes my situation..* This field is required.

I have the resources to invest to save my marriage.

I have access to the resources to save my marriage (or I am willing to get resourceful).

I have no access to resources and am unwilling to get resourceful to save my marriage.

Have you seen our Free Masterclass yet?* This field is required.(If the answer is no, please watch it at www.turnaroundmarriage.live)

YES

How Did You Hear About Us (Facebook, Masterclass, Friend)?If you were referred by someone, kindly share who so we can thank then?

Do you promise to show up for your appointment ON TIME and DISTRACTION FREE (no driving)? Please CONFIRM by typing "Yes I will" in the box below.* This field is required.

Final Question: On a scale of 1-10, how big of a priority is this for you right now?1-10 (10 is Highest Priority)