PRIVATE COUPLES RETREAT
Private Couples Retreat Questionnaire
For your confidentiality and privacy, Miles is the only one who will read your answers.
First and Last Name of both people
How did your hear about our couples coaching and/or retreats?
How long have you been a committed couple?
Do you live together, have children, share finances?
Have you been to couples coaching or counseling before? If so, how did that work?
What kind of help do you think you need now in your relationship?
Are you looking for a single in-person session, online sessions, or to book a couples retreat? What dates are you available?
Thanks for submitting!