Current Plans

Describe what plans you have for the future of this relationship.

Your line of work

Your religion

Sliding scale cost of coaching

How to calculate

Tell us what you hope to gain from coaching?

What are your strengths as a couple?

What have you done to help figure out if marriage is the next right step?

Please give us some indication of where you are in your relationship currently.

Please give us some idea of your current level of motivation.

How happy are you currently with the sexual connection you share?

Please describe what you hope for in a sexual relationship when married.

List the top five hesitations you have as you consider marriage.

Have either of you received counseling/coaching in the past?

No/I have/they have/we both have | When? | For what?

Have either of you threatened violence or break up?

No/I have/they have/we both have | When?

Under what circumstances do you each withdraw from the relationship?

I do/they do/we both do | To what degree? | For how long?

Under what circumstances do you each press for more attention from the other?

I do/they do/we both do | To what degree | Describe resolutiion

Comments

If you have anything more you'd like to share, please explain here.

What are the top three things you could do to improve the relationship?

Additional details about yourself

Additional details about other

Limitations of marriage coaching

1 - Coaching will not diagnose nor treat mental illness. Coaching cannot replace psychological counseling by a licensed practitioner. If you are concerned that mental illness may play a role in your marriage, we recommend an evaluation by a licensed professional. 2 - Coaching is different than counseling. I understand that my coaches are not trained to help me with addiction, abuse, infidelity, nor mental illness. I recognize that coaching is not psychotherapy. 3 - No guarantees have been made as to the expected outcome of my coaching. 4 - As a coaching client, I understand and agree that I am fully responsible for my own choices, decisions, and wellbeing. 5 - I am aware that either my coach or I can choose to discontinue coaching at any time. 6 - I understand that coaching can only bring the change I truly desire through my full and active participation. Coming prepared to each coaching session is mission critical.

Privacy Statement

All personal information collected by Two by Two Marriage Missionaries will be held in confidence. Contact and personal information will only be used to keep records, process payment and send information to you. All content raised during coaching sessions will be kept in confidence. There are four exceptions. 1. If Client threatens or attempts to commit suicide or otherwise conducts him/her self in a manner in which there is a substantial risk of incurring serious bodily harm. 2. If Client threatens bodily harm or death to another person. 3. If Coach has reasonable suspicion that Client is the perpetrator, observer of, or victim of physical, emotional or sexual abuse. 4. If a court of law issues a subpoena for information stated on the subpoena. I understand that our coaches may need to consult with other professionals in order to provide the best coaching to me or to share lessons they learn. Information about me may be shared in this context without using my name or other identifying details.

Please list top five topics you'd like to address in coaching.

1 - to be addressed first

Intake Form for a couple discerning Marriage