Stepmom Coaching Intake Form
Email address *
Your name, age and occupation *
Your answer
Partner's name, age and occupation *
Your answer
What's the best number to reach you at for our session? *
Your answer
Stepchildren's names and ages *
Your answer
Biological children's name and ages (if applicable)
Your answer
How long have you and your partner been together? *
Your answer
How long have you and your partner been living together? *
Your answer
Provide names of any relevant extended family including your partner's ex, her partner if she is repartnered, your ex, your in-laws, etc...
Your answer
What is the current custody schedule? (50/50, 80/20, one week on one week off, etc...) *
Your answer
How long were your partner and the ex together? How long have they been separated? *
Your answer
Describe your relationship with your partner. (No problems, only fight about the kids, etc...) *
Your answer
Describe your relationship with your stepchildren *
Your answer
How would you describe your partner's relationship with the ex? (Good, contentious, neutral, etc...) *
Your answer
Describe your relationship with your partner's ex. (No communication, friendly, so-so, she's crazy, etc...) *
Your answer
What would you like to accomplish/gain from your coaching session with me? (Better communication with partner, how to bond with stepchildren, how to deal with ex, etc...) *
Your answer
Have you ever had coaching or therapy for these issues? If so, what worked for you? What didn't work? *
Your answer
What else would you like me to know before our session(s)? *
Your answer
How did you hear about me? *
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