Are you a here to apply for mentorship to save your marriage? *

Yes

No

First & Last Name *

Email *

Phone *

How long have you been married?

Do you have children? What ages? *

What are you struggling with most right now in your marriage? *

What do you want your marriage to look like if you achieve your goals in the next 90 days? *

How long have you been trying to find a solution for your marriage? What specifically have you already tried (counseling, coaching, books, retreats)?

How are things going in other areas of your life (work, health, finances)?

What is your profession? (this helps me better understand you from a behavioral science perspective)

Are there any legal proceedings for domestic violence or orders of protection in place at this time?

How committed are you to doing the work to save your marriage?

I'm 100% all in to do whatever it takes

It's important but not my top priority

I'm not sure I want to commit

My programs require action to create change. If we feel partnering together is a good fit for both of us, how quickly are you looking to take action?

I can make a decision on the call

I will want to take time to reflect for no more than 24 hours and decide

I am not really a fast action taker and will need a week or more to process

My programs are not free, but they do work. If we decide partnering together is a good fit, what is your current ability to invest?

I have cash available now

I have credit available to get started

I would need to figure out how to get resourceful

My assets are frozen in the divorce process

I am not willing to invest right now, I just want information

On the following page you will be able to schedule a call with Jeanine... Will you 100% be able to make the time you choose? We do not reschedule no-shows. *

Yes - I give my word I will be there

Maybe - I'm not sure if I'm serious

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