Couple's VIP Weekend Retreat
Use this form *only* for the VIP retreat. This is not for counseling or weekly coaching sessions.
Both your names (First and Last) *
email ( **please** check as one wrong letter means I cannot reply to you) *
Location *
How did you hear about me? *
I recognize you have options in choosing a professional to work with. To be sure we are well suited, describe what resonated about my work and why you have selected me. *
Tell me about your experience in intimacy & relationship coaching, your goals as a couple and any other relevant info. No need to share deeply personal information, just an overview so I know what you're hoping to work through / experience. *
What hesitations do you have, if any, about taking this opportunity together at this time? *
Please check before sending the form *
This is a rich embodied experiential weekend program. We are both over 21 and we both recognize this is a commitment we are willing to engage in. If we are a good fit, we have the means and resources to accommodate a weekend of this caliber. *
Please indicate your affiliation with any of these communities/ identities/practices *
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