#RealWifeMovement Questionnaire
Creating Strong Marriages, One Wife At A Time!
Disclaimer:
Due to the recent increase in domestic violence, the Real Wife Movement is not able to assist anyone who is a victim of it. If you have any form of a restraining order (also called a “protective order”) against your boyfriend or husband, we are not able to assist you. Our team researches every application that is submitted. Please call 1-800-799-7233 (SAFE) for assistance.

Thank you for your understanding and cooperation.

Today's Date
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First Name
Your answer
Last Name
Your answer
Email
Your answer
Phone Number
Your answer
Best Time to schedule your Initial REAL Wife Conversation
Your answer
Age
Martial Status
Years married
1. What is the biggest challenge regarding your relationship/marriage that you are facing right now?
Your answer
2. How would your life be impacted if you were able to overcome that challenge?
Your answer
3. Rate how you feel about the below relationship factors
Extremely Unsatisfied
Unsatisfied
Neutral
Satisfied
Extremely Satisfied
Sex
Parenting
Finances
Extended Family
Friends
4. If there was something not included in the above list, please share what it is and rate it.
Your answer
5. What type of support are you interested in?
6. Are you prepared to invest the time and work necessary for your personal growth in order to improve your relationship/marriage?
7. Are you prepared to invest in yourself financially within the next 30 days?
8. If you answered "no" to #7, what do you need to financially invest in yourself?
Your answer
9. Would you like for Tanya to speak at your next event(church, women's group, sorority, etc.)?
10. How did you find out about The Real Wife Movement or Being a Wife Just Got Real?
Your answer
Being a Wife Just Got Real Book Launch Q&A
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