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Morrow Marriage Presents: The White Picket Fence Project

Thank you for your application to The White Picket Fence Project. The following questions will help us evaluate your relationship in the following categories: Communication, Sex, Family, Finances and Commitment Level. Please choose your answers carefully - the goal of this survey is to see if you qualify to work with Kathryn.

Communication

When you think about your normal pattern of communication with your husband, which of the following are present? Please select all that apply. *

Yelling

Name Calling

Eye Rolling

Negative Body Language

Lying

Accusing

Ignoring

Interrupting

Shutting Down

Stonewalling

Defensiveness

Criticism

Contempt

Verbal Threats

Belittling

Berating

Swearing

Misunderstanding

Language Barriers

No Communication

No problems - Communication is good

In your opinion, what is the biggest communication issue in your marriage? Please give 2-3 sentences. *

What strategies, if any, have you already tried to improve the communication patterns in your marriage? *

Sex

When considering the intimate side of your marriage, please select all that apply: *

Infidelity (physical)

Infidelity (emotional)

Infidelity (suspected but not confirmed)

Sexual Abuse/Assault

Low Libido/ Low Desire

Unmatched Sex Drives

Pregnancy/new baby/small children in the home

Nothing- Sex has never been our problem

Sex is (select all that apply): *

A job - we do it, but one of us doesn’t really want to

Rare or non existent

A source of conflict

None of the above - sex is not one of our problems

In 2-3 sentences, please outline the issues (if any) regarding intimacy in your marriage: *

Family

How long have you been together? *

2 years or less

3-5 years

6-10 years

More than 10 years

How many children do you have? *

0

1-3

4 or more

Do you have a blended family? *

Yes

No

What best describes the stage of life you are currently in? Select all that apply: *

No Children

Infant

Toddler/Preschooler

Elementary/Middle School

High School

Adult Children/Empty Nest

Disagreements regarding parenting styles/discipline/ punishments is causing a lot of conflict in the home: *

Which statement best describes your “home” roles: *

Both partners play an equal part in parenting, pet care, household tasks and general household management. We are happy with our roles.

Division of work at home is unequal but we are content with our current roles. We have bigger problems to worry about.

Division of work at home is completely unfair and is causing conflict in the home.

Please give us your info below:

First Name *

Last Name *

Email *

Phone *

I agree to terms & conditions provided by the White Picket Fence Project. By providing my phone number, I agree to receive text messages for appointment reminders from the White Picket Fence Project, average of 4 (SMS) messages per month. Message and data rates may apply. Text "STOP" to unsubscribe at any time. Text "HELP" for Help.

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Commitment

We only work with people who are ready to make a change. If invited, and this is a mutual fit, are you sure you are ready to sign up TODAY? *

Sign me up - I’m ready.

I'm not sure.

Not ready.

Finances

Which of the following describes your current financial situation? *

Money is not an issue at all!

Money might be an issue, depending on cost.

Money is an issue.

I have no money at all.

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