Husband Contact Info

First Name

Last Name

Phone Number

Email Address

Wife Contact Info

First Name

Last Name

Email Address

Phone Number

General Info

How long have you been married?

How would you currently rate the health of your marriage relationship 1-10? How would you currently rate the health of your marriage relationship 1-10? 12345678910

How many children do you have? How many children do you have?0123456789101112131415

Please list each child and their ages.

What are the top 3 biggest points of conflict in your marriage currently?

Point 1:

Point 2:

Point 3:

What would you hope to achieve by going through our marriage intensive?

We hope to...

If accepted, you will be placed in 1 of 2 groups that will meet every other week. Because spots are limited, we are looking for couples that will be able to commit to all 7 weeks without missing a session. If accepted are you able to commit to all 7 weeks? If accepted, you will be placed in 1 of 2 groups that will meet every other week. Because spots are limited, we are looking for couples that will be able to commit to all 7 weeks without missing a session. If accepted are you able to commit to all 7 weeks? Yes No