COUPLES’ INTAKE QUESTIONNAIRE

Your Name

First Name

Last Name

Partner's name

First Name

Last Name

How long have you and your partner been together?

Have you been in any kind of therapy or coaching before? How would you describe your experience?

What resonated with you the most about my practice? What are you looking for in a therapist or coach?

How would you describe the biggest challenge in your relationship right now?

What are three of your biggest strengths as a couple?

On a scale of 1-10, how would you rate your level of hopefulness about creating change in your relationship?

(1- Not at all hopeful, 10- Extremely hopeful)

Is there anything else you would like me to know before our call?

Do you have any burning questions that you definitely want me to address in our call?

FOLLOW US ON THE JOURNEY!