Tell Us A Little About Yourself and

Then Select Your Chosen Time Slot

Your confidentiality is paramount & your information will solely be used to prepare for our appointment.

1) Full Name *

2) Spouse Name *

3) Please confirm your Age *

21 - 30yrs

31 - 40yrs

41 - 50yrs

51 - 60yrs

Above 60yrs

4) Please confirm your Spouse's Age *

21 - 30yrs

31 - 40yrs

41 - 50yrs

51 - 60yrs

Above 60yrs

5) How long have you been together or married? *

1 - 5yrs

5 - 10yrs

10 - 15yrs

15 - 20yrs

20 - 25yrs

Over 25yrs

6) What are the main issues you are facing in your relationship? *

7) How soon can you commit to start rebuilding your marriage or relationship? *

Today

I Still Need Time

8) Are you fully committed to being punctual and ready for the call?

We will 100% be there together.

I will do my best to get my spouse to join me.

I will 100% be there on my own.

I'll book but I'm not sure I will turn up.

8a) Which of the following best describes you?

I have access to my own financial resources and I can make financial decisions without my spouses approval.

My spouse and I make financial decisions together. I would be able to make a decision but I would have to check with my spouse first.

I don’t have any access to financial resources. My spouse controls all the finances and I can’t make any investment without his permission.

9) If someone advised me I needed to invest at least $3000 to fix my marriage, I would say... *

My marriage is extremely important to me and I am willing to invest in fixing it.

I am living paycheck to paycheck and although my marriage is really important to me I would need to discuss payment plan options to spread the cost.

Money is a constant source of stress - sadly, I don't have any funds or credit to invest in saving my marriage at this time.

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