Couple’s Work Coaching

intake form

This intake form is designed to help me understand your goals, challenges, and how best I can support your transformation. Please answer the following questions as honestly and thoroughly as possible.

Name of Partner A

First Name

Last Name

Name of Partner B

First Name

Last Name

Phone

Country

(###)

###

####

What is your preferred method of contact?

Text

Where did you hear about us?

What is your relationship style?

How long have you been together?

Do you have any children?

Yes

Have you previously sought any form of couples or relationship coaching?

What is you greatest strength as a couple?

How would you describe your current sexual relationship?

What is your biggest weakness as a couple?

Are there any sexual challenges or concerns that impact your relationship? Or any specific sexual dynamics or patterns you would like to address or explore?

(e.g., frequency, preferences, fantasies)

Please describe any current challenges or obstacles you are facing in your relationship.

What do you hope to achieve for yourself from this mentorship?

What has held you back from having (answer to last question) on your own?