Couples Coaching Intake Form

Instructions:

Each partner should complete this form separately and privately before your first session. Your answers will not be shown to your partner. Your coach will read both forms and may draw on themes that come up, but nothing will be quoted verbatim. This is intended to give each of you space to reflect honestly before we meet together.

There are no right or wrong answers. The more honest you are, the more useful this becomes.

Basic Info

MM slash DD slash YYYY
Name(Required)
Are you currently living together?
Do you have children (together or from previous relationships)?
e.g. Mine – 8, lives with me full-time / Partner's – 13, splits time

SECTION 1: What Brings You Here

1. What brings you here? (Select 2–3)
Relationship:
If children from previous relationships are part of your life:
2. Which best describes where you are in this relationship right now?
3. Blended Family — If children are involved, which best describes your current thinking about blending families?

SECTION 2: Where You Are Now

SECTION 3: Growth & Vision

SECTION 4: Communication & Emotional Experience

14. How would you describe your communication styles?
SECTION 5: Preferences
19. Would you like us to incorporate any of the following into your coaching experience?(Check all that apply)