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LIFE COACHING
RELATIONSHIP COACHING
RELATIONSHIP COACHING SERVICES
IF YOUR RELATIONSHIP IS NOT WORKING OR YOU HAVE A HISTORY OF BROKEN RELATIONSHIPS - COMPLETE THE FOLLOWING PLEASE.
Relationship Coaching Application form
Name
*
First
Last
Valid and Private Email
*
Please provide us with a private email so that we can contact you directly and confidentially
Sexual relationship - choose ONE of the following that most applies to you
*
My partner can't make love to me
My partner makes me feel like I am sexually inadequate
We have sex once a week
When we have sex, he ejaculates too quick
When we have sex she makes me nervous and I ejaculate too quick
We have sex maybe once a month - if we are lucky
He doesn't have a clue about foreplay so I get turned off sexually everytime he makes an advance
She doesn't enjoy sex and won't allow me or us to explore each other
She uses sex as a bargaining tool for material gain or to get what she wants from me
My partner can't make love to me the way I wish he/she could
My partner is sexually bored with me and makes it known - I feel like a failure
Trust - Please choose one of the following that MOST applies to you
*
My partner doesn't listen to me
My partner doesn't share what's on his/her mind
My partner is harsh in his/her criticism and I feel I fail their expectation
I fear my partner is bored with me
My partner doesn't connect emotionally with me but expects sexual pleasure from me
I feel picked on and put down
We seem to want different things
I feel judged and rejected by my partner
We have become nothing more than room mates
My partner constantly compares me to others
I chose my partner for the wrong reasons
I envy my friend's relationships
I am suspicious of my partner
My partner is jealous and too possessive of me
My partner has passwords on cel phones - sometimes refuses to answer calls (for no reason)
My partner uses "work" as an excuse to spend time away from home and family time
My partner acts suspicious lately
Emotional - Please choose one of the following that most applies to you
*
I am always stressed and don't know how to relax
My body is always full of stress aches and pains
I suffer with anxiety
I've given up on my dreams for the sake of raising a family
My kids drain me
I don't feel appreciated and noticed
My partner and I don't connect emotionally the way we used to
My partner and I live past each other
My partner and I have lost respect for each other
We fight and argue alot
My partner and I aren't "in love" with each other any more and life has become hard
We've lost our joy and life is "hard work" and no fun
Submit