Full Name

Age

 Relationship Status 

 What are you currently looking for in your dating or relationship life? 

 What would a successful outcome from coaching look like for you? 

 What are your top 3 goals right now when it comes to relationships? 

 What has been your biggest challenge in dating or relationships? 

 What patterns do you feel keep repeating in your experiences? 

 What have you already tried to improve your situation? 

 What do you believe you need to improve about yourself in relationships? 

 How do you typically handle conflict or disagreements? 

 How do you communicate your needs to a partner? 

 Do you feel you have strong boundaries in relationships? Why or why not? 

 Have you ever stayed in a situation longer than you should have? Explain. 

 How do you define a healthy relationship? 

 Are you currently dealing with a specific person or situation you want to discuss? 

 Are you open to direct feedback and being challenged? 

 Are you willing to complete reflections or homework between sessions? 

 I understand that coaching requires honesty, effort, and accountability. 

 I understand that results depend on my willingness to apply what I learn. 

What is the one thing you truly want to change about your dating or relationship experience right now?