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Welcome to GuardYourEyes!

To join our website and get access to all the tools and services that we offer, please spend a few moments to fill out the details of this form so we can suggest to you the best possible route of help for your situation. As soon as you've submitted this form, you will get access to our network and be able to contact us to get personalized help.

The information that you submit will be kept fully confidential. This is a secure form and this information will be used only to better help you.

Dear friend,

please fill out the following form so that we can guide you to the best solutions appropriate for you.

The information will be kept fully confidential. This is a secure form and this information will be used only to help you in your 90-day challenge.

חבר יקר,

על מנת לוודא שתוכנית 12 הצעדים מתאימה עבורך, אנו מבקשים שתמלא את השאלון הבא.

שים לב: כל הפרטים יישמרו בדיסקרטיות מלאה, ולא יועברו לשום גורם בשום מצב.

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Your email will only be used for getting in touch with you to help you reach your goal. It will be kept absolutely confidential and will not be visible to others. But if you are more comfortable being totally anonymous, click here to open a new anonymous email account (example: StrugglingYid@gmail.com)
The challenge can be different at various ages. That's why it's important that we know how old you are so we can guide you accordingly.
Gender*
For women there is a completely separate system, administrated only by women.
How would you best describe yourself?*
Feel free to write a few words about your background and your situation so we can better guide and advise you. If there is anything significant in your situation that wasn't covered in the questions above, this is the place to tell us.
This will be your Username in our system
Try to choose something easy to remember
Where did you hear about us?
You can choose multiple replies