Couples Coaching Intake Form

Instructions:

Each partner should fill out this form separately and privately before the initial meeting. This allows for individual reflection and gives us a fuller picture of your relationship dynamics, strengths, and intentions. Your responses are confidential and will only be used to tailor your retreat experience.

SECTION 1: Basic Info

MM slash DD slash YYYY
Name(Required)
Are you currently living together?
Do you have children (together or from previous relationships)?

SECTION 2: Where You Are Now

SECTION 3: Growth & Vision

SECTION 4: Communication & Emotional Experience

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