Coaching Questionnaire - For Couples SMW Name:* First Last Partner Name:* First Last Phone:*Address:* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Email:* DOB:* MM slash DD slash YYYY Astrological Sign:* Age:*Have you been in a long-term relationship before your current relationship?* Yes No If yes, how many years? Were you married?* Yes No Do you have any children with your former relationship?* Yes No If yes, how many and what are their ages?What did you like about your former partner?*What went wrong?*How long have you been separated?*How would you describe your current relationship?*How long have you been together?*Are you married?*Do you have any children?*If yes, how many and what are their ages?How did you meet?*What do like about your partner?*What are your 3 favorite things about your partner?*What is the hardest thing you have overcome in your relationship?*What major transitions have you recently had in your life and relationship? ( examples: entering or approaching a new decade of life, a new job, a new role, a new residence, changes in children’s ages/stages of life, death of a loved one, birth of a child, marriage, etc.)*How would you describe your personality?*How would your friends and family describe your personality?*How do you perceive yourself when you look at yourself in the mirror?*What are your primary stressors?*Where were you born and raised?*Where did you grow up?*Do you have any siblings? Are you close to your parents?*Do you have any pets?*How would you describe your partner’s personality?*What does your usual week look like? (work, family, friends, wellness, spirituality, etc.)*Where do you see yourself with your partner a year from now?*What are some of the values you were raised with that you share with your partner?*What is your primary motivation for engaging in this coaching process?*What are some of the differences between what you have currently and what you want to have in life and in relationship with your partner?*What challenges, if any, have you recognized that may be holding you back from achieving this in your life?*Pinpoint three to five areas that you would like to address in our coaching sessions:*What outcome would you like to receive from our coaching sessions together?*Why is this outcome important to you?* Join our mailing list NameThis field is for validation purposes and should be left unchanged. Δ