check

Questionnaire (Couples)

Please complete this questionnaire at least 12 hours before we speak.

Click the button below to start the questionnaire. 

Start

Question 1 of 9

Rank the following in order of most important in your life to least important, putting the most important first. 

Family
Relationship with Spouse/Partner
Self-care
Career
Travel
Health
Personal Growth
 

Question 2 of 9

What do you do for work?

Question 3 of 9

Briefly describe your relationship.

Question 4 of 9

What is the most pressing challenge/obstacle in your relationship?

Question 5 of 9

What do you really want from your relationship and why is that not happening now?

Question 6 of 9

Why will working with a coach help you at this time?

Question 7 of 9

Rate your desire to change on a scale of 1-10. (10 is the highest.)

Question 8 of 9

In your opinion, rate your partner's desire to change on a scale of 1-10. (10 is the highest.)

Question 9 of 9

Anything else you would like to share before our conversation?

Confirm and Submit