Relationship Space Jakarta

Relationship Space Jakarta

Thank you for your interest in working with me. This form will help me understand your relationship, goals, and how I can best support you using the Gottman Method. All information is confidential.
Name

First NameLast Name
Gender

MaleFemale
Phone Number
Please enter a valid phone number.
Email
example@example.com
Preferred language

EnglishFrench
Are you seeking support as...

An individualA couple / with a partner
If seeking coaching as a couple:

DatingEngagedMarriedDivorced / SeperatedOther
Do you and your partner both consent to participate in coaching?

YesNot yetI’m not sure
If seeking coaching as an individual, Are you currently in a romantic relationship?

YesNoIt's complicated
What would you like to explore or work on in coaching? (You can select more than one)

Improve communication skills[Understand and change unhelpful relationship patternsHeal from a past relationship or breakupBuild healthier future relationshipsDeepen emotional or physical intimacyNavigate a life transition (parenthood, separation, etc.)Reconnect as a coupleRebuild trustI’m not sure yet — just exploringOther
Anything else you’d like me to know before we begin?
What days/times generally work best for you for sessions? (weekday mornings, evenings, weekends, etc.)
Thank you for sharing. I’ll be in touch shortly via WhatsApp to schedule our first session and answer any questions you might have.
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