Couple Questionnaire | Six 24 Life

couples coaching intake form

The purpose of this form is to ask preliminary questions to determine the level of coaching we would need to provide. Questions regarding mental health are strictly asked to ensure that we are coaching within the state of Illinois guidelines. SIX 24, LLC is not a mental health licensed practice.

Would you consider both parties mentally healthy at this time in your life?

YES

If either of you have a diagnosed mental illness or disorder, Are youcurrently under the care of a mental health professional?

YES

Don't Have Mental Illness/Disorder

Are you two interested in moving forward toward the future or are you interested in coaching to explore some past issues in order to move forward?

We want to move forward toward the future.

We need to explore some past issues first before moving forward.

do you both want coaching as a space to vent and heal or a space to take action and move toward the future?

We want to vent and heal.

We're ready to take action.

Your information is received and I look forward to speaking with you!