Couples Coaching Form

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Partner (A) Name
First Name
Last Name
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Age of Partner (A)
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Partner (B) Name
First Name
Last Name
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Age of Partner (B)
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What email would you like to register with?
example@example.com
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What phone number would you like to register with?
Please enter a valid phone number.
7
What kind of relationship are you in?Please choose one or more options.
Committed Monogamous. ( 2 partnered relationship)
Open Relationship ( Each or one partner having multiple partners)
Long Distance Relationship
Marriage
Engaged
Dating
Committed & Parenting
Same Sex Couple
Other
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If you answered "other" please describe your relationship in a short sentence below.
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How many years have you been together?
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What is the highest vision for your relationship? What do you both wish to see and experience as a couple?
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What do you feel has been the #1 challenge you've been facing?
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What forms of therapy/coaching/processes/experiences/practices have you tried in terms of overcoming these challenges?
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Have either of you experienced a level of big "T" trauma? If "Yes", please briefly explain what it is & the impact that it has on you and/or the relationship today. (Please include names if this is for 1 or both partners)Big "T" traumas would include physical abuse, sexual abuse, a recent death, acute or physical illness.
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Is there anything else you feel I should know?
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Before submitting this form, you agree you are aware in the differences between Therapy vs Coaching for couples. Therapy for couples is focused on healing past traumas by resisting past experiences to discuss and reframe them in the present, therapy is not goal-focused and is more directed towards solving a problem. Coaching focuses on a goal/vision/objective and is future focused. We focus on the goal and apply practices and methodologies within the present moment to overcome challenges to achieve the desired outcome. This does not mean we won't heal ancestral trauma, it just won't be the core focus. By clicking "yes" you agree and understand the value stated above.
YESNO
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Before submitting this form, you acknowledge that booking a 1:1 or 1:2 discovery call entails exploring the possibility of collaborating within a coaching framework, which will involve a financial commitment.During a scheduled discovery call, we'll delve into a deeper understanding of each other. I'll explore your desired outcomes, challenges, and dynamics, aiming to determine if our coaching is compatible for you as a couple. By clicking "yes," you acknowledge that this call will culminate in a decision regarding our potential collaboration. Should we decide to proceed together, there will be a financial commitment required during the call.
YESNO
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Do you have a photo of the two of you? (Optional)This is just for fun!
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