Name (optional)

First Name

Last Name

How consistently do you spend time alone with God theough His Word, prayer, etc. (i.e. "quiet time")? *

Please select only one option.

1 (rarely)

2

3

4

5 (every day)

If married, how healthy is your relationship with your wife?

Please select only one option. Please skip if unmarried.

1 (toxic)

2

3

4

5 (thriving)

How connected are you with other brothers in Christian community? *

Please select only one option.

1 (surface level)

2

3

4

5 (deep/intimate)

Of the struggles listed below, indicate the three you most often encounter: *

Please select only three options

Alcohol / Substance abuse

Anger

Anxiety / Stress

Arrogance / Judging others

Bitterness

Busyness / Overcommitment

Depression

Discontent / Complaining

Discouragement

Greed

Identity

Indebtedness / Financial irresponsibility

Jealously / Envy

Laziness

Materialism / Covetousness

Pornography / Sexual lust

Revenge / Retalliation

Selfishness / Lack of generosity

Spiritual leadership in the home

Uncontrolled speech / Cursing

Other (please describe below)