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Home
About us…
Our Services
Events
Contact
Book your Appointment
Book your Room
Surveys
Survey CC&C B.V. English
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Please enable JavaScript in your browser to complete this form.
1. Gender
*
Male
Female
2. Have you ever heard about the services CC&C B.V. has to offer?
*
Yes
No
3. How satisfied are you in your current relationship?
*
Very satisfied
Satisfied
Neutral
Not that satisfied
Not satisfied at all
4. Would you like to receive guidance regarding your relationship?
*
Yes
No
5. If your answer was "Yes" on the previous question, in what form would you prefer this to be?
*
Personal, Individual
Personal, Group
Online, Individual
Online, Group
Other
More than 1 option is possible / If your answer is "Other" Use the box below
6. If your answer was "Yes" on the previous question, in what form would you prefer this to be?
*
Mail of written tips
Mail of video with tips
Whatsapp of written tips
Whatsapp of video with tips
Seminar with valuable information
Retreat weekend
Support Group with different topics
Session for personal guidance
Social activities for couples
Other
More than 1 options are possible / If your answer is "Other" Use the box below
7. If your answer was "Yes" on the previous question, what topics would you be interested in?
*
Communication
Connection
Infidelity
Trust
Sexuality
Other
More than 1 option ispossible / If your answer is "Other" Use the box below
8. If your answer was "Yes" on the previous question, what would/could you invest in this?
*
< fl.25
fl.25 - fl.50
fl.50 - fl.75
fl.75 - fl.100
fl.100 - fl.125
fl.125 - fl.150
fl.150 - fl.175
fl.175 - fl.200
> fl.200
9. What would keep you from receiving guidance regarding your relationship?
*
Money
Motivation
Fear
My partner
Other
More than 1 option is possible / If your answer is "Other" Use the box below
10. Is there anything else you would like to say about the services of CC&C B.V.?
Email
Email
Confirm Email
Not necessary...Only if you are interested in receiving more information. (Answers will be processed anonimously).
Number di telefon
Not necessary...Only if you are interested in receiving more information. (Answers will be processed anonimously).
Phone
Submit