Fill out this form for questions about our services or to share your story.

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Subject (While we are sometimes flooded with emails and I can't respond to all of them, I do, however, read every one, so if you'd definitely like to hear back from me, feel free to add something like "Please write back" to your subject line.)

Check All That Apply (required)

 I am interested in a free Group Call. I'm interested in the lower-cost mentoring options available right now ($49-150/mo). I am a Coach/Counselor/Helper for others dealing with this issue. I would like to help others dealing with this issue. Other / I just want to tell my story.

Your Message:

NOTE: If you'd like to share your story or if you'd like to get further faster in our work together, feel free to answer the following questions.

Here you can give your story of betrayals with the year they happened; include any time you've felt blamed for this.

On a scale of 1-10, how do you feel about your relationship?
(1=you are one step away from being completely done; 10=your marriage couldn't get any better)

On a scale of 1-10, where is your level of inner stability right now?
(1=you feel you are going crazy every day; 10=you are completely clear headed and never trigger anymore)

How does he feel about his problems with sexual integrity?

What help have either of you already sought, and what seems to work the best?

Are there any other factors complicating the issue?

If you would like a one-to-one introductory call, let me know [a] the time zone in which you live and [b] what times are generally good for you, and we'll add something to the schedule. (Please know that I am out of the office until next week, but am currently scheduling appointments about 2 to 6 weeks out.)

How did you hear of our program?

* * * My emails sometime go to spam, so after hitting SUBMIT below, be sure to add admin{at}pornpainhealed{dot}com to your email contacts OR check your spam folder from time to time. Also, if hitting SUBMIT below causes what you wrote to disappear, it means your form was submitted successfully. * * *

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