Dr. Lurve Couples Consultation Intake Form

To get the most out of each coaching session, please take a moment to consider the following questions prior to our session. It will help guide our session for maximum impact.

Please take a moment to consider how you want to use your time with me. I invite you to be open and honest in your answers.

Your Name

First Name

Last Name

Partners Name

First Name

Last Name

Why are you seeking relationship coaching?

What is your biggest challenge when dealing with this?

Have you ever had help/coaching/therapy to help with this challenge?

What areas of your life have been affected by this challenge?

What would your ideal outcome be after coaching? (What do you want?)

How long have you been a couple for?

What are some of your fondest memories in your relationship?

Has there been any infidelity? Please give details

What is your occupation? What is your partners occupation?

How old are you? How old is your Partner?

Do you have children? How many, how old and what are their names?

How much time do you spend with each other?

Do you kiss each other hello and goodbye every day?

How often do you have sex?

Are you attracted to your partner still?

What is the one pet hate about your partner?

What is the one thing you adore about your partner?

Is there anything that could get in the way of you getting the results you want?

Have you been diagnosed with a mental health disorder? Are you medicated?

Is there anything else you think I should know before we embark on our coaching journey?