Sliding Scale Coaching Application
We at The Modern Mr. and Mrs. want to make sure we are accessible to those from varying socioeconomic levels and hold spots for individuals and couples that are looking to change their marriage and lives that need a sliding scale.

By filling out this application you are applying to be a coaching client at a lowered rate.

Do know that there are limited spots of clients we can take that need financial assistance.

We reserve the right to request evidence of your income in the form of pay stubs, tax returns, or other documents in order to qualify for discounts.

Once we receive your application we will email you for proof of income and we will discuss whether you qualify for sliding scale.

Formats of Coaching That Applies to Sliding Scale:
- Individual Sessions ($160, $128, $96/session)
- Couples Sessions ($240, $192, $144/session)
- Email Coaching ($330, $265, $200/month)
Sign in to Google to save your progress. Learn more
Enter full name(s) here *
Best Email *
Are you and your partner married? *
Country *
City *
State *
Zipcode *
Cell Phone (and name of the partner who's number it is) *
Do you prefer call or text or email contact *
Clear form
Never submit passwords through Google Forms.
This form was created inside of The Modern Mr. and Mrs.. Report Abuse