Request a Marriage Mayday Rescue Call

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Name *

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Email *

Email

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Address *

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City

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I won't send physical mail to your address, but your address helps me validate you're a real person. Also, as a business professional, this information goes into my CRM system so that I may better serve you and keep professional records.

Best time to call (include timezone pls) *

What do you do for a living?

Marital Status

How long?

Do you have children? *

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What led you to contacting me today? *

What changes would you like to see the most in your life? *

What do you see as the biggest barriers to these changes you desire? *

Do you struggle with any addictions? *

No
Yes

Please explain how you struggle with addictions *

Have you had any issues with Depression, Anxiety, or ADD/ADHD (Attention Deficit Disorder/ Attention Deficit Hyperactivity Disorder)?

No
Yes

Please explain what issues you have or have had with depression, anxiety, ADD/ADHD *

Are you currently seeing a therapist? *

No
Yes

Please explain why you are receiving therapy

Are you currently working with another coach or mentor? *

No
Yes

A lot of men feel guilty for reaching out to a coach or mentor when they're already working with one. However, It's quite normal for men to pursue different insights and perspectives from many sources. Answer Yes only if you are actively being coached or mentored in a professional capacity.

Coach or Mentor you're currently working with *

Don't worry, I'm not going to contact them, this just helps me understand your current context

How many books do you read in a year? *

How serious are you about beginning a mentoring program? *

I’m just looking into it but not ready to make a time or money investment in myself
I’m serious and want to invest in myself, but I don’t know how to get going
I’m ready to get going and make the necessary investments to do it

What do you believe must happen in your life before you'll be ready to make such an investment into yourself?

How did you hear about me?

Would you like to receive a very occasional email newsletter? *

New emails are only sent when new blog posts or articles are posted or when I have new courses or materials available.