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 AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Email:* DOB:* Date Format: MM slash DD slash YYYY Astrological Sign:*Age:*Have you been in a long-term relationship before your current relationship?* Yes NoIf yes, how many years?Were you married?* Yes NoDo you have any children with your former relationship?* Yes NoIf 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?*PhoneThis field is for validation purposes and should be left unchanged.