Full Name *

Spouse's Name *

Best Contact Phone *

Best Contact Email *

Years together: *

Tell us a little about your relationship and how long you’ve been together/kids/work/businesses?

Tell us about what initially attracted you the the couple’s mastermind:

How would you rate your relationship now in terms of Commitment: (scale of 1-10)

How would you rate your relationship now in terms of Passion and Intimacy: (Scale of 1-10)

How would you rate your relationship now in terms of Communication: (scale of 1-10)

How would you rate your relationship now in terms of Support: (scale of 1-10)

This mastermind isn’t for couples in crisis or needing intensive therapy. We are high level coaches who have extensive backgrounds in coaching and methods to help you and your partner create lasting change, connection, and love. Are you and your partner currently in crisis? (Yes/No)

What do you love about your relationship?

What do you struggle with or wish could change?

If you were to look through to the other side, what would you hope to see on the other side of the next 4 months after completing the mastermind? What would your ultimate desire and hope be for?

If selected, would you be able to invest the $25,000 into this intimate, immersive relationship mastermind? (Payment plans available)