How many years have you been married? Together as a couple? *

Where are you in the process of dealing with your Spouse's Midlife Crisis as it relates to Bombdrop (the time since you received the shock that they want a divorce or discovered the infidelity? (Select a Choice). *

What is your current marital living situation? *

Married, Spouse is still home

Separated

Currently in the Mediation or Divorce Process

Divorced

Any Children? If Yes, what ages? Do they live at home with you? Pets? *

Marital Home Status: Are either of you in the home? Selling or sold the home? Where do you live now? *

What are your goals for your marriage or a new romantic partner at this time? *

I'm standing for my marriage.

I am looking to move forward with my life but am still open to reconciliation.

I am not standing and want to move on with my life, but not yet interested in dating.

I am dating and want a new romantic partner.

I've tried dating but taking a step back.

I am in a new romantic relationship.

What is the biggest problem you are facing now? *

What results are you looking to achieve as it relates to your personal wellbeing or circumstance? *

What exactly have you tried that has not worked to overcome the frustration, anxiety, anger and despair you experience resulting from your spouse's midlife crisis? *

Is there anything else you want to share or feel is important for me to know about you or your circumstance? *

Full Name *

Phone *

Email *

US State or Country You Live In?

Time Zone (EST, CST, PST, ...)

Facebook Profile/ Link (I'd love to send you a friend request if you want)

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