(DEE) Application Form
After completing this brief questionnaire, you will be provided a link where you can schedule a 30-min call with me to discuss your unique situation and determine if the DEE program is the right fit for you!
Question 1 of 14
What are the top 3 roadblocks you are dealing with in your marriage?
Question 2 of 14
How many years have you been together? How many have you been married for?
Question 3 of 14
What is your biggest concern or fear in regards to these challenges?
Question 4 of 14
Is there a significant financial concern if you were to divorce?
Question 5 of 14
Why is it essential that you make a change right now?
Question 6 of 14
Where do you see yourself in 5 or 10 years if you do not make this change?
Question 7 of 14
If you could wave a magic wand and have your ideal marriage, what would it look like?
Question 8 of 14
What have you done to attempt to improve your marriage? Why do you think this has not created the desired outcome?
Question 9 of 14
Do you have children? If so, how old are they and who are the parents?
Question 10 of 14
Have you been married before? Describe how many times and how those marriages ended.
Question 11 of 14
Are you or your partner struggling with any physical, mental, or emotional health issues? Are you currently or have you been under medical treatment?
Question 12 of 14
Have you or your partner now or in the past, struggled with addiction to drugs, alcohol, or sexual addiction? Are you involved in any support groups?
Question 13 of 14
Are you both at least mildly interested in saving the marriage? (Y/N, I don’t know)
Question 14 of 14
Phone number