Hybrid And Intensive Application Form
Looks like you're ready to take things to the next level for coaching and accountability. Let's get to work!
Basic Information
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
What is the worst part and the biggest challenge about your marriage right now?
*
Why are you applying for more support? What are you hoping to achieve?
*
Are you ready, willing and able to make an investment of $,7,500 to $15,000+ financial investment to get the expert training, coaching and accountability to help you be a stronger man who creates a stronger, more passionate marriage? (This can be a business expense if you have a business)
*
Yes
No
Do you commit to being emotionally and sexually faithful to your wife while we work together?
*
Yes
No
Send Dr. Mike My Application And Schedule My Interview
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