BraveCouple Questionnaire PLEASE NOTE: Your answers will be kept confidential and will not be shared. Your Personal Information Name * First Last * Last Email Address * Phone Number * City * Your Age * Under 18 18-24 25-34 35-44 45-54 55-64 65 or Above Your Spouse's Information Spouse's First Name * First Spouse's Last Name * Last Your Spouse's Age * Under 18 18-24 25-34 35-44 45-54 55-64 65 or Above Your Relationship Why are you interested in the BraveCouple Retreat? * What are the greatest challenges in your relationship is at the moment? * What would you like to improve about your relationship? * How HAPPY are you both in your relationship right now (scale of 1-10) 1 2 3 4 5 6 7 8 9 10 How CONFIDENT are you both in your relationship right now (scale of 1-10) 1 2 3 4 5 6 7 8 9 10 How SATISFIED are you both in your relationship right now (scale of 1-10) 1 2 3 4 5 6 7 8 9 10 How did you hear about Philip * Is there anything else you would like to add that you feel is important? Δ