Consultation Data Form – Monica Humpal Coaching

Name *

First

Last

Email *

Mobile Phone *

Are you currently working to heal and mend your marriage after your husband's affair? *

Yes
No

Which of these are you struggling with the most right now? (check all that apply) *

What have you tried so far to help you manage these issues? (check all that apply) *

Tell me about your affair recovery journey so far. Provide some history about you, your husband, and what has transpired since you found out about the affair. *

What is your biggest obstacle right now with yourself or your marriage? Be as specific as possible. *

What are your biggest fears/concerns right now and as you look to the future? *

Describe the life and the marriage you desire as specifically as you can. *

What, specifically, would you like Monica to help you with on this call? *

Try to limit this to one main issue - two at most.

How soon are you looking to start coaching?

Coaching is an investment in yourself and your future. How WILLING and ABLE are you to invest the energy, commitment, and financial resources to create the transformations you are seeking?* *

I have the willingness, drive, and financial resource to invest in myself and my marriage
I do not have the willingness, drive, and financial resources to invest in myself and my marriage