Intake Questionnaire New Client Intake Questionnaire Tell me about yourself Relationship status: —Please choose an option—singlemarrieddivorcedseparatedwidowedco-habitating List improvements or changes you would like to make in the following areas of your life: Relationships, Love, Sex, Social, Professional, Family, Personal, Health-Physical. Self Assessment List 3 adjectives that describe you at your best List 3 adjectives that describe you at your worst What do you think has been holding you back from achieving your goals? (Include any obstacles, experiences, fears, concerns, people, etc.) What are the things that stress you out the most? What motivates you the best? Who did you learn about relationships and sex from? What did they tell you? Have you ever worked with a coach, counselor or therapist before? If yes, what worked well for you and what did not work? How would you describe the best relationship that you’ve had? How would you describe the most difficult relationship that you’ve had? How would you describe a perfect relationship for you? Love Coaching Acknowledgement I am aware that Love Coaching is not sex therapy, psychiatry, or psychology. I have read and understood The Fine Print Please type your full name as a digital signature: Δ Share this:FacebookXLike this:Like Loading...
