Couple Questionaire - Couples Synergy

What best describes you?

Wife

Husband

Fiance

Single

In a relationship

How long have you been in this relationship?

6-12 Months

10 years +

What are your ages?

20's

30's

40's

50's

Do you have Kids together?

No

Yes

We don't want kids

We would to have kids someday

What is your biggest struggle right now?

Our conversations are mostly around work, no romance

We are physically secure (House, cars, etc) but I know our emotional and Spiritual Connection is broken

verything is falling apart. Our marriage. Kids not excelling in the world

Judgment from others. Not looking perfect all the time.

Feel pressure in all areas of my life...career, financial, from my partner

Where do you want to see yourself in the next six months?

Feeling loved, appreciated and heard by my partner

Having a love life that makes my heart beat fast and puts a big smile on my face

Getting on the same page with my partner so we are building something together

Filling up my cup so I can pour my love onto others and live abundantly

Getting to the root of my fears and finally unleashing my inner strength

What steps do you feel are needed to achieve your dream?

Educating myself on how I can become a better human being

Taking a brief pause from everything and do some deep Self reflection

Gaining Greater insight within myself to fully understand my present

I’d like to talk more with my partner about anything and everything

This program is designed for couples who are committed to reaching new levels in 90 days, on a scale from 1-10 how committed are you?

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