Helping Husbands Survey

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* 1. Your Contact info.

First Name

E-mail address

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* 2. His Friendships... My Husband has

7 or more close male friends

3 or more close male friends

1 close male friend

No real close male friends

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* 3. His Work: My husband

Loves his career/job and is in the right place.

Likes his job/career and is in a reasonable place.

Doesn't like his job/career and is likely in the wrong place.

Hates his job/career is is definitely in the wrong place.

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* 4. His Life Fulfillment: My husband

Loves his life today

Accepts his life today

Feels mostly disappointed with his life today

Feels deeply dissatisfied with his life today

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* 5. His Health: My husband

Is in great health

Is in reasonable health

Is really needing to pay better attention to his health

Is in poor health

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* 6. His Family: My husband

Totally prioritizes time and energy with his family

Typically prioritizes time and energy with his family

Struggles to balance time and energy with his family

Is really out of whack when it comes to time and energy with family.

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* 7. Our Marriage: My husband

Invests in our marriage as a top priority

Typically puts our marriage as a top priority

Does not put our marriage as a top priority

Does more damage to our marriage than good.

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* 8. His Finances: My husband

Helps create a financially healthy climate

Does what he can to create financial health

Struggles with financial health

Is in financial crisis and needs help

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* 9. His Spirituality: My husband

Invests in his own spiritual growth as a top priority

Cares about his spiritual growth

Doesn't do much about his spiritual growth

Is totally disconnected in this area of his life.

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* 10. Holding Him Back: What would you see facilitating breakthrough for your husband at this point (choose as many as apply)

Intentional male friendships/community

A career change

A new job position in his existing career

A career breakthrough retreat

A program to learn allocate his time and energy

Personal soul care

An ongoing mentor or coach for life/career

A men's group/network to help him

A marriage breakthrough retreat

Marriage group

A marriage counselor

Personal Counseling/therapy

Parenting/family guidance/coaching

Spiritual direction/guidance

Financial coaching/counseling

Nothing

Other