How long have you been in your current Relationship?
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Less than 7 years
7-15 years
15+ years
I'm not in a Relationship
Do you have kids?
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Yes
No
If so, how many kids, and what age range?
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What's working well in your relationship? what's not working well?
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How's your Relationship doing...Most Relationships are in one of 3 places:
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Red (Struggling, and disconnected)
Yellow (Good Partnership, like Roommates)
Green (Great Foundation, ready to THRIVE!)
Other
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Tell me about yourself... What's your name?
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First Name
Last Name
If you are struggling to create connection in your relationship, tell me a little about the challenges you have encountered so far...
*
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Are you and your partner currently living under the same roof?
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Yes
No
If so, are you sharing a bed together?
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Is there anything specific you want to focus on when it comes to your relationship (Communication, Conflict Management, Intimacy, Sex, Shared Vision, etc.)?
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If you could start learning the skills to Revive your Relationship within the next week, would you be interested?
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Yes
No
Maybe
Are you able to commit at least 2 hours per week to learn and implement new skills to Revive your Relationship?
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Yes
No
Not Sure
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What's the best email for me to send you a video explaining exactly how I help men Revive their Relationships?
example@example.com
What kind of situation are you in right now?
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I want help, but I can't afford to invest in myself.
I want a DIY solution (Money's tight and I would rather learn it and do it myself)
I want a Done with Me Solution (Do the work myself, with specific coaching on what to fix)
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