For GMW | Finding Bliss 4.0

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Name:*

First Last

Phone:*

Address:*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email:*

DOB:*

Astrological Sign:*

Age:*

Have you been in a long-term relationship before?*

Yes

If yes, how many years?

Were you married?*

Yes

Do you have any children?*

Yes

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 personality?*

How would your friends and family describe your personality?*

How do you perceive yourself when you look at yourself in the mirror?*

Where were you born and raised?*

Where did you grow up?*

Do you have any siblings? Are you close to your parents?*

Are you out to your family? Are they accepting to your sexual orientation?*

Do you have any pets?*

How would you describe your potential partner’s personality?*

What does your usual week look like? (work, family, friends, wellness, spirituality, etc.)*

Where do you see yourself a year from now?*

Do you see yourself with your partner a year from now?*

What are some of the values you were raised with that you want to 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?*

What challenges, if any, have you recognized that may be holding you back from achieving this in your life?*

Pinpoint three or 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?*

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