The Spark Intensive Application

Congratulations on your interest in The Spark Intensive transformational program!

Name

Please enter the same information you used to schedule your appointment.

Email Address

US Phone Number

What's the best # for this call? If outside the US enter 555-555-5555 and see the next question.

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If outside the US, what is your complete phone # (including country code)?

How long have you been with your current partner?

What's not working in your intimacy?

If nothing changes, what will this be like in 5 years? 10 Years?

On a scale of 1-10 (if 1 is not at all and 10 is absolutely), how committed are you to solving this problem?

With our help, what would you LOVE your intimate life to look and feel like?

What else would you like us to know?

Right now....

I have the resources to invest in a professional solution for my intimacy troubles.

I have access to resources to receive professional help for my intimacy troubles.

I don't think my intimacy troubles are that serious.