COUPLES INTAKE
Before Your First Session
Preparing for Our Work Together
Thank you for taking this step towards creating a more conscious, connected and fulfilling relationship.
Before our first session, I ask that both partners complete a few important forms. These help me understand your individual experiences, the strengths and challenges within your relationship, and what each of you hopes to achieve through therapy.
Please allow approximately 20 minutes per person to complete the forms.
Your Pre-Therapy Forms
1. Client Service Agreement & Informed Consent
Please read and sign this agreement, which outlines confidentiality, consent, fees and important information about how we'll work together.
2. Private Pre-Therapy Screening
This confidential screening helps me understand your individual circumstances and identify any important considerations relating to safety, wellbeing and the suitability of couples therapy.
3. Conscious Couples Assessment
This assessment explores the current strengths and challenges within your relationship, including the foundations of commitment, emotional safety and connection.
4. Couples Satisfaction Questionnaire (CSI)
This questionnaire provides a snapshot of your current experience of relationship satisfaction, helping us establish a starting point from which to evaluate progress.
Download Satisfaction Questionnaire
How to Complete Your Forms
Complete them separately. Each partner should independently complete the screening, assessment and satisfaction questionnaire. You may return one service agreement signed by both partners.
Be open and honest. There are no right or wrong answers. Please respond according to your own experience, without consulting your partner.
Save your completed PDFs. Download each form, fill it in and save your responses.
Return them before our first session. Please email your completed forms directly to me, with each partner sending their individual responses separately.
If you have any questions or difficulty completing the forms, please get in touch.
Measuring Our Progress Together
Therapy is not simply about understanding the problems in your relationship. It's about creating meaningful and lasting change.
Throughout our work together, we'll revisit the Conscious Couples Assessment and Couples Satisfaction Questionnaire.
This allows us to recognise progress, reflect on what's changing, identify areas that may need more attention and ensure we're working towards the outcomes that matter most to you.
These assessments aren't tests to pass or fail. They're tools for greater awareness, reflection and growth.
Thank You
I genuinely appreciate the time and care you put into completing these forms.
Your willingness to reflect honestly on yourself and your relationship is already a meaningful first step in our work together.
I look forward to meeting you both.
Mike

