Relationship Quiz

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Application form for a free couples coaching session with Kathy & Mikal from F.Y. Couples Coaching

Hi there, please fill out this short form to apply for a free 90 minute couples coaching session. Please note, this is for couples only - not individuals.

8Questions

1
How long have you been together as a couple?* This field is required.
Less than 3 year
3-7 years
8-15 years
16-25 years
26+ years
2
Please let us know your first names?* This field is required.
3
Do you have children?Please give as much or little info as you wish, ie how many, ages, at home/left home, etc.
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Ok
4
What would you say is working the best in your relationship?* This field is required.Tick as many boxes as applies.
Communication
Spending time together
Physical intimacy
Having fun
Dealing well with conflict
Supporting each other
5
What would you say is not working so well in your relationship?* This field is required.Tick as many boxes as applies.
Communication
Spending time together
Physical intimacy
Having fun
Dealing well with conflict
Supporting each other
6
What would you like to gain from a coaching session with us?* This field is required.
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7
Anything else you would like to share?
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8
And finally, we will need an email so we can get back to you.* This field is required.
example@example.com
Should be Empty:

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