Appointment

How long have you been together?

Relationship statusco-habitingdatingengagedmarried

Any previous relationship with financial or other commitments.YesNo

Do you have any children from previous relationships?YesNo

How long were you married?

What are the primary reasons for the divorce?Irreconcilable differencesInfidelityLack of communicationEmotional AbusePhysical abuseSubstance AbuseFinancial IssuesIntimacy IssuesParenting DifferencesLife Changes/TransitionsLoss of TrustLack of SupportPersonality ClashesOther

Do you have children?YesNo

Are there any high-conflict issues involved (e.g., custody disputes,
financial disagreements)?YesNoSome

Have you been in therapy before?YesNo

What are your primary reasons for seeking therapy at this time?
AnxietyDepressionRelationship issuesTraumaGriefLife TransitionsSelf-esteemOther

What are you hoping to achieve through therapy?
Improve coping skillsGain self-awarenessStrengthen RelationshipsProcess TraumaManage Emotions

Which of the following best describes the biggest challenges you and your partner are currently facing?Communication difficultiesIntimacy issuesTrust issuesFinancial disagreementsParenting conflictsExternal stressorsLife transitionsIndividual challengesOther

How long have you been together?
Less than 2 years2+ years

What are your goals for relationship coaching?Improve communication skillsIncrease emotional intimacyBuild trust and connectionResolve conflict effectivelyDevelop greater empathy and understandingStrengthen commitment and loyaltyEnhance shared goals and valuesImprove problem-solving abilitiesIncrease relationship satisfactionOther

What are some of the strengths you bring to your relationships?
Good communication skillsEmotional intelligenceEmpathy and compassionHonesty and trustworthinessCommitment and loyaltyFlexibility and adaptabilityProblem-solving abilitiesConflict-resolution skillsPositive outlookSupportive and encouraging natureOther

Please briefly describe the situation you'd like assessed.

What are your desired outcomes?

What specific areas of support are you looking for?Emotional support and counselingCo-parenting support and guidanceLegal advice and assistanceSocial support and community buildingSelf-esteem and confidence buildingStress management and coping skillsDating and relationship adviceOther

How long has it been since your divorce was finalized?
Less than 6 months6 months to 1 year1 to 2 years2 to 5 years5+ years