Eleanor Haack-Finney
Free Marriage Discovery Call
Eleanor Haack-Finney
Board Certified Christian Counselor & Life Coach
15 Minutes
Personal Information
First Name
Please enter your first name.
Last Name
Please enter your last name.
Email
Please enter a valid email.
Time Zone
-------------
(GMT-12:00) International Date Line West
(GMT-11:00) American Samoa
(GMT-11:00) Midway Island
(GMT-10:00) Hawaii
(GMT-08:00) Alaska
(GMT-07:00) Arizona
(GMT-07:00) Mazatlan
(GMT-07:00) Pacific Time (US & Canada)
(GMT-07:00) Tijuana
(GMT-06:00) Central America
(GMT-06:00) Chihuahua
(GMT-06:00) Guadalajara
(GMT-06:00) Mexico City
(GMT-06:00) Monterrey
(GMT-06:00) Mountain Time (US & Canada)
(GMT-06:00) Saskatchewan
(GMT-05:00) Bogota
(GMT-05:00) Central Time (US & Canada)
(GMT-05:00) Lima
(GMT-05:00) Quito
(GMT-04:00) Caracas
(GMT-04:00) Eastern Time (US & Canada)
(GMT-04:00) Georgetown
(GMT-04:00) Indiana (East)
(GMT-04:00) La Paz
(GMT-04:00) Puerto Rico
(GMT-04:00) Santiago
(GMT-03:00) Atlantic Time (Canada)
(GMT-03:00) Brasilia
(GMT-03:00) Buenos Aires
(GMT-03:00) Montevideo
(GMT-02:30) Newfoundland
(GMT-02:00) Mid-Atlantic
(GMT-01:00) Cape Verde Is.
(GMT-01:00) Greenland
(GMT+00:00) Azores
(GMT+00:00) Monrovia
(GMT+00:00) UTC
(GMT+01:00) Casablanca
(GMT+01:00) Dublin
(GMT+01:00) Edinburgh
(GMT+01:00) Lisbon
(GMT+01:00) London
(GMT+01:00) West Central Africa
(GMT+02:00) Amsterdam
(GMT+02:00) Belgrade
(GMT+02:00) Berlin
(GMT+02:00) Bern
(GMT+02:00) Bratislava
(GMT+02:00) Brussels
(GMT+02:00) Budapest
(GMT+02:00) Copenhagen
(GMT+02:00) Harare
(GMT+02:00) Kaliningrad
(GMT+02:00) Ljubljana
(GMT+02:00) Madrid
(GMT+02:00) Paris
(GMT+02:00) Prague
(GMT+02:00) Pretoria
(GMT+02:00) Rome
(GMT+02:00) Sarajevo
(GMT+02:00) Skopje
(GMT+02:00) Stockholm
(GMT+02:00) Vienna
(GMT+02:00) Warsaw
(GMT+02:00) Zagreb
(GMT+02:00) Zurich
(GMT+03:00) Athens
(GMT+03:00) Baghdad
(GMT+03:00) Bucharest
(GMT+03:00) Cairo
(GMT+03:00) Helsinki
(GMT+03:00) Istanbul
(GMT+03:00) Jerusalem
(GMT+03:00) Kuwait
(GMT+03:00) Kyiv
(GMT+03:00) Minsk
(GMT+03:00) Moscow
(GMT+03:00) Nairobi
(GMT+03:00) Riga
(GMT+03:00) Riyadh
(GMT+03:00) Sofia
(GMT+03:00) St. Petersburg
(GMT+03:00) Tallinn
(GMT+03:00) Vilnius
(GMT+03:00) Volgograd
(GMT+03:30) Tehran
(GMT+04:00) Abu Dhabi
(GMT+04:00) Baku
(GMT+04:00) Muscat
(GMT+04:00) Samara
(GMT+04:00) Tbilisi
(GMT+04:00) Yerevan
(GMT+04:30) Kabul
(GMT+05:00) Almaty
(GMT+05:00) Ekaterinburg
(GMT+05:00) Islamabad
(GMT+05:00) Karachi
(GMT+05:00) Tashkent
(GMT+05:30) Chennai
(GMT+05:30) Kolkata
(GMT+05:30) Mumbai
(GMT+05:30) New Delhi
(GMT+05:30) Sri Jayawardenepura
(GMT+05:45) Kathmandu
(GMT+06:00) Astana
(GMT+06:00) Dhaka
(GMT+06:00) Urumqi
(GMT+06:30) Rangoon
(GMT+07:00) Bangkok
(GMT+07:00) Hanoi
(GMT+07:00) Jakarta
(GMT+07:00) Krasnoyarsk
(GMT+07:00) Novosibirsk
(GMT+08:00) Beijing
(GMT+08:00) Chongqing
(GMT+08:00) Hong Kong
(GMT+08:00) Irkutsk
(GMT+08:00) Kuala Lumpur
(GMT+08:00) Perth
(GMT+08:00) Singapore
(GMT+08:00) Taipei
(GMT+08:00) Ulaanbaatar
(GMT+09:00) Osaka
(GMT+09:00) Sapporo
(GMT+09:00) Seoul
(GMT+09:00) Tokyo
(GMT+09:00) Yakutsk
(GMT+09:30) Adelaide
(GMT+09:30) Darwin
(GMT+10:00) Brisbane
(GMT+10:00) Canberra
(GMT+10:00) Guam
(GMT+10:00) Hobart
(GMT+10:00) Melbourne
(GMT+10:00) Port Moresby
(GMT+10:00) Sydney
(GMT+10:00) Vladivostok
(GMT+11:00) Magadan
(GMT+11:00) New Caledonia
(GMT+11:00) Solomon Is.
(GMT+11:00) Srednekolymsk
(GMT+12:00) Auckland
(GMT+12:00) Fiji
(GMT+12:00) Kamchatka
(GMT+12:00) Marshall Is.
(GMT+12:00) Wellington
(GMT+12:45) Chatham Is.
(GMT+13:00) Nuku'alofa
(GMT+13:00) Samoa
(GMT+13:00) Tokelau Is.
Additional Information
Welcome
Welcome to Mission Resilient Christian Counseling & Coaching.
Thank you for scheduling your complimentary Marriage Discovery Call. This brief intake helps us understand your relationship and determine the best way we can serve you.
Please complete this form together if possible. If only one spouse is completing it, answer as honestly as you can. Your responses are confidential.
Full Name
Please enter your response.
Email Address
Please enter your response.
Phone Number
Please enter your response.
Preferred Method of Contact
Phone
Text Message
Email
Please select your response.
Spouse/Partner's Name
Please enter your response.
What prompted you to schedule a Marriage Discovery Call?
Please enter your response.
About Your Relationship
How long have you been married?
Select
Engaged
Less than 1 year
1–5 years
6–10 years
11–20 years
20+ years
Please select your response.
Do both spouses intend to participate in sessions?
Select
Yes
No
Unsure
Please select your response.
What would you like help with?
Communication
Conflict Resolution
Emotional Connection
Parenting
Military Life
Blended Family
Financial Stress
Trust
Infidelity Recovery
Intimacy
Faith & Spiritual Growth
Premarital
Other
Please select your response.
On a scale of 1–10, how would you rate the current health of your marriage?
1 = We are in crisis
10 = We are thriving
Please input a number between 1 to 10
Have you previously attended marriage counseling/coaching?
Yes
No
Please select your response.
Scheduling Preferences
How would you prefer to meet?
Select
Virtual
In Person
Either
Please select your response.
Preferred appointment times
Morning
Afternoon
Evening
Please select your response.
Before We Meet
Important Information
Is your relationship currently experiencing any of the following?
Physical abuse
Emotional abuse
Active affair or infidelity
Separation
Divorce has been discussed
None of the above
Please select your response.
Is there anything else you'd like me to know before we meet?
Please enter your response.
Are you seeking:
Marriage Counseling
Marriage Coaching
Unsure of the difference
Please select your response.
