The Ultimate Relationship Coaching Application
Are you ready to create the lasting change in your relationship for you and your to be happy, fulfilled and thriving? Let's see if we are the right fit in working together. We are taking a limited number of coaching clients and want to make sure that you both are ready to commit to your Ultimate Relationship! And please note, all information contained herein is confidential.
Name of primary contact
Primary contact phone number
Your partner's name
Your partner's email address
Ages of you and your partner
Do you have children?
If yes, how many?
What are the ages of your children?
Please check the areas in your relationship in which you and/or your partner are feeling stuck, unhappy or dissatisfied (choose as many as applicable, and still check the box even if only one of you is experiencing)
Generalized stress / anxiety
Decrease in intimacy
Frequent arguing without resolution
Little in common
Unsure about future of relationship
Spiritual crisis (you and your partner differ in spiritual needs and/or beliefs)
Socially disconnected (few, or poor, friendships; little community)
Difficulty making decisions
Experiencing major life transition (relocation, aging, illness...)
Extended family stress
Please expand, if you'd like, on any checked box from above...
How long have you felt stuck?
What have you done so far to work towards creating change?
If you have done some work (therapy, self-help, etc...) what has been helpful? And what hasn't been helpful?
Do you believe that growth and change are possible?
No...that feels really hard
I think so, but am a bit hesitant
Are you able to commit to weekly 1-hour calls?
Please share any additional information you'd like us to know in working with you
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