Couples Intensive Application: A Transformational Experience
This is not traditional couples counseling—this is a transformational, results-driven experience designed for couples who are serious about breaking patterns, rebuilding trust, and strengthening their relationship. Completing this application is the first step. Due to the nature of this work, limited spots are available. If selected, you will receive next steps, including scheduling and payment details.
I understand this is an in-person, immersive Couples Intensive that requires full participation. (Checkbox required to proceed.)
I understand
Couple's Information
Partner 1 Full Name
Partner 2 Full Name
Phone Number (For scheduling & consultation purposes only.)
Best Email Address for Both Partners
Phone Number (For scheduling & consultation purposes only.)
How long have you been together?
Please Select
Less than a year
1-3 years
4-6 years
7+ years
Relationship Readiness & Intensive Goals
Relationship Readiness & Intensive Goals (Screening Section - Open Responses Required)
1. What is your primary reason for seeking this Couples Intensive?
2. What has been the biggest challenge in your relationship?
3. Have you tried couples counseling before? If so, what worked? What didn’t?
4. On a scale of 1-10, how committed are you both to doing the necessary work to heal and strengthen your relationship?
Not Ready
1
2
3
4
5
6
7
8
9
Fully Committed
10
1 is Not Ready, 10 is Fully Committed
5. What outcome do you hope to achieve from this experience?
Important: Your responses help determine if this Intensive is the right fit for you. Only serious applicants will be considered.
6. Scheduling & Availability (Required Selections - In-Person Only)Select Your Preferred Intensive Format:
*
One-Day Private Intensive
Two-Day Weekend Intensive
7. Preferred Date Range:
*
This Month
Next Month
Open to the Next Available Spot
Spots are limited and reserved on a first-come, first-served basis. Once your application is reviewed, you will receive a confirmation email with next steps.
Investment & Commitment Agreement (Final Confirmation Before Submission)
This Couples Intensive is a high-impact, results-driven experience designed to create lasting transformation in your relationship. As a premium offering, payment is required to secure your spot.
✔ I understand that this Intensive requires a financial commitment and is non-refundable.
*
I understand
Payment & Final Registration
Once your application is reviewed and approved, you will receive an official invoice with payment instructions. Payment must be completed to finalize your spot.
✔ I agree to complete the payment upon receiving the official invoice.
*
I agree
Submit
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