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Alison's Extraordinary Relationship Intensive Application


Extraordinary Relationship Intensive Application
* indicates required field
First Name *   
Last Name *   
Phone Number *   
Email Address * 
(confirm)  
Gender *   
Co-Participant's Full Name *   
Co-Participant's Email Address *   
Co-Participant's Gender *   
Form of Relationship * 

What is the form of your relationship? (Ex: Committed and living together. Committed/not living together. Married. Married/Separated, etc.)

 

How Long Together * 

How long have you been together?

 

If married, how long have you been married?

 

Quality of Relationship * 

Please rate the quality of your relationship at this time, from 1-10, where 1 is "needs rescuing,"
5 is "okay, but wouldn't want to do this forever", 9 is "ready to go from good to great."

 

Relationship's Strengths * 

What do you consider to be your relationship's top 5 strengths?

1.  

2.  

3.  

4.  

5.  

Frustrations/Problems/Concerns * 

What are your top 5 frustrations, problems or concerns in your relationship?

1.  

2.  

3.  

4.  

5.  

Results * 

What are your top 5 results you intend to achieve by participating in this Intensive?

1.  

2.  

3.  

4.  

5.  

Share with Partner? *  Will you share these responses with your partner?    

Need to view the Intensive Terms and Conditions?

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