Questionnaire

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Are you in a relationship?* This field is required.

YESNO

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How long have you been in your relationship?* This field is required.

Less than a year

1-3 years

4-5 years

6-9 years

10+ years

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On a scale of 1 to 10 how would you rate your relationship? (or your last relationship).* This field is required.1 = Divorce Imminent / 5 = Meh, It's Fine / 10 = Consistently Sexy And Loving.

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When you argue, how often do you find yourself getting defensive or numbing out just to cope with her intensity?* This field is required.

Less than 20%

More than 20%

More than 40%

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Do you find yourself getting defensive with your woman?This is a common (but toxic) dynamic and I want to see if it is part of your situation

Yes, she complains that I do it all of the time

Yes, but I'm just responding to her twisting the facts or unfairly blaming me

No. She says I do, but I don't see it

No, its not really a factor in our dynamic

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How often do you get anxious or numb when her emotions are activated?Anxiety and numbness are huge blockers to you being able to settle her, so its relevant to the specific strategies you employ

I stay pretty solid when she’s fired up

Sometimes I get anxious or numb, but can usually shake it off

Sometimes I get anxious or numb, and it goes poorly from there

I can’t handle her emotions, so I get anxious or numb immediately

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When your woman has emotional outbursts, how often does it lead to a fight?* This field is required.

Less than 10% of the time

10-40% of the time

More than 40% of the time

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How strong are your nice guy pleaser tendencies?* This field is required.

I NEVER try to please. I do what’s authentic and right.

I’m an easy-going guy, so I often go with her opinion on things. It’s easier that way

I admit it - I’m a nice guy. I don’t like it about myself, but I’m often trying to please others or keep the peace

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How often do you suppress your emotions or not speak your truth?* This field is required.Both are well-known causes of turbulence. We need to know if this is a factor. Be honest.

Most of the time. It just leads to trouble and I can handle things internally

Some of the time. There are certain topics/emotions I just avoid.

Never. I’m pretty much an open book whether she likes it or not

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Has your woman expressed that she wants you to “take the lead” on things more?* This field is required.She wants to relax into your direction, and will likely complain when that’s not happening

Yes, she has said that to me one or more times.

Not explicitly, but she often leads because she’s constantly thinking ahead

No, I’m pretty good at leading on a lot of things in our life

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How often is it her planning your social/recreational activities? * This field is required.

Not often. I’m the planner for the two of us

Half the time. It’s a pretty even split, not really biased either way

Sometimes. She does most of the planning/initiating of what we do

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How much sex are you having?* This field is required.Sex is a barometer for the health of the relationship, so this tells me a lot

Once a day

Once a week

Once a month

A few times a year or less

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What is your typical role in the initiation of sex?* This field is required.The dynamics of your sexuality tell us so much about the relationship. Hence the question

I wait for her to initiate because I’m tired of being rejected

After we go to bed, I reach over and caress her and see if she responds

I verbally share that I would like to be physically intimate with her

No sex is happening

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Who is initiating variety and novelty in your sex life? - i.e. trying new things to expand your sexual repertoire, whatever that means for you.* This field is required.

My woman, mostly

Me, mostly

Neither of us

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What usually happens after you two have an unresolved fight?* This field is required.Lack of resolution of unfinished fights is such a common source of tension. Hence the question

You hope that she forgets about it and it blows over

You bring up the topic of debate and ask if she wants to process it some more

She brings it up again to process it some more

No one says anything and it just (seemingly) goes away

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Do you feel satisfied with your skills of diffusing the situation when her emotions get intense?* This field is required.

No, I’m pretty baffled by her emotions

Sort of. Sometimes I can handle things. Other times it’s a mess

Yes. I’ve worked hard at my skills of diffusing things when she’s fired up

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Has your woman said “I don’t feel emotionally safe with you?” or “I don’t feel emotionally connected to you?* This field is required.

Yes. And I can feel it - she’s pretty flat/distant towards me but I don’t know why

Yes. And she explained why and it makes sense

No. And she seems pretty heart-open towards me most of the time

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How often does your woman have emotional outbursts that seem “crazy”?* This field is required.

Once a day

Once a week

Once a month

A few times a year or less

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Would you say that your woman is overly critical of you?* This field is required.

Yes. I can’t do anything right in her eyes

Yes. It’s not too frequent, but enough that it creates bad feelings in me

No. She complains a bit, but only once in a while

No.

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On a scale of 1 to 5 how committed are you to doing whatever it takes to repair your relationship?* This field is required.

1 = I no longer care and can’t muster the energy to try

2 = I will work at this, but only as hard as she does

3 = I definitely want to work on this, but I’m skeptical that there’s a resource out there that can help us

4 = I’m ready to put in the work for meaningful change

5 = I’M 100% ALL IN - time, money, and guts are not a barrier

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If you found a path to repairing your relationship, AND take it to a better place than it has ever been before, would you be willing (and able) to invest in the help and support necessary to get there?* This field is required.If at some point you DO want my help to revitalize your relationship I want to make sure I pair you with the best mentorship opportunity possible

Yes. This is super-important to me, and I have the cashflow to invest $2,900 or more into the coaching and resources necessary to get me there.

Yes. This is super-important to me, and I have the funds/credit to invest $2,900 or more into the coaching and resources necessary to get me there.

No. I’m living month to month right now, and can’t invest financially into my relationship at the moment.

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CallQual

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What is your first name?* This field is required.

First Name

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Pleasure to meet you {FirstName}, what is your last name?* This field is required.

Last Name

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What is your phone number?* This field is required.

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{FirstName}, what is the best email to contact you about your results?* This field is required.

example@example.com