Application for Couple's Intensives 
I'm excited and honored that you are here and look forward to getting to know you better and exploring the possibility of us working together. My guess is that you have probably done all the things (therapy, self-help books, meditation, podcasts...) and while things may have improved a bit, yet not enough to fully feel satisfied or healed. I am also guessing you are here because you ready to create the lasting change that you desire to be happy, fulfilled and content. In making sure that I am the right coach for you, please take your time in filling out this intake so that I can be sure to provide you with the best support and guidance when we connect. Enjoy the process as this truly is the first step in your Journey Forward®. Please note, all information contained herein is confidential.
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Email *
Partner's email address *
Name (you and partner) *
Please provide both of your phone numbers and specify whose number each is *
City and state you reside *
Status of your relationship *
Do you have children? If so, what are their ages and please specify if they reside with you *
What inspired you to reach out and apply to work with me 1:1? *
Is there a current stressor that has impacted your relationship or are you experiencing ongoing challenges? *
Have you done couple's work together before, and if so, what was successful and what was not helpful? *
Are either of you in individual therapy at this time? If so, please expand on how long you've been in therapy and if you are experiencing any positive shifts?
Please check the areas of your relationship in which you would like to Journey Forward®
 *
Required
Please expand on the areas in which you are experiencing dissatisfaction and the degree of impact are they having on your life, sense of self, relationships, focus & attention, and/or direction in your life, both individually and as a couple? Please be as thorough as possible to provide context for me to get a clear picture of your current experience.  *
How long have you been feeling stuck in the areas you mentioned above and what have you done (i.e. therapy, coaching...) to work on it? *
In what areas have you have felt improvement and where have you felt no movement or progression towards the desires you are seeking? *
What are the things you can identify that are standing in the way of achieving your desires? *
If you could wave a magic wand, without experiencing any worry, fear or anxiety regarding the outcome - if you truly tapped into your heart's desire - what would shift in your relationship? *
Are you ready to release the old stories, limiting beliefs, habits or patterns that are no longer serving you?
 *
Do you have a... *
Please share any additional information you'd like me to know about you before working together. *
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