Let's Unwind with the Evans
Marriage Reboot services
Preliminary Section
Name
First Name
Last Name
Partner's Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Date of Marriage
-
Month
-
Day
Year
Date
Marriage Reboot Questions
What do you love most about your partner?
Do you feel emotionally supported?
Yes
No
What are your goals for marriage counseling?
To improve communication and understanding in our relationship.
To rebuild trust and emotional connection.
To resolve ongoing conflicts and strengthen our bond.
To gain tools and guidance for a fresh start in your marriage.
What communication habits would you like to improve?
Please Select
Managing tone and body language
Avoiding blame or criticism
Expressing feelings clearly
Communicating needs and expectations
How would you rate your current level of emotional and/or physical intimacy?
Worst
1
2
3
4
Best
5
1 is Worst, 5 is Best
What does a "rebooted" marriage look like to you?
Are there specific topics you want to focus on?
Are there any infidelity issues? (Emotional/Physical)
Yes
No
Submit
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