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First Name*
Email*
What best describes you?*
What best describes you?*
I want to quit looking at porn and don’t know where to begin.
I’ve tried everything to stop looking at porn and feel powerless.
I know I need help, but I also know I need someone else to help me.
I just need to get past my shame and closer to God.
I'm trying to help my husband or boyfriend stop looking at porn.
None of these describe me.
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Name
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Email
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Who are you submitting this reference for (first and last name)?
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How long have you been (or were) a client?
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Are you still a coaching client?
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How would you rate your overall satisfaction with the coaching services you received?
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Extremely Satisfied
Satisfied
Not Very Satisfied
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How would you rate the overall value of your coaching experience (service vs. cost)?
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Extreme value for the cost
Fair value for the cost
Value was lacking compared to the cost
Value was extremely lacking compared to the cost
How likely are you to refer this coach to someone else?
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Likely
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Extremely Unlikely
How would you rate the effectiveness of the coaching services you received?
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Effective
Not Very Effective
Extremely Uneffective
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