Book a Couples Coaching Session or Intensive

Intake Form for Couples Coaching
Conscious Communication Sessions & Intensives
For your privacy, your answers are held in strict confidentiality.

First and Last Name of Person #1

First and Last Name of Person #2

Phone

How did your hear about Miles and Conscious Communication Couples Coaching?

How long have you been in a primary, committed relationship? Do you live together? Do you have children that live with you? Do you share finances?

Have you had communication coaching or counseling before? If so, how did that work?

Have you read the Conscious Communication book or the Conscious Communication for Couples book, or taken the Conscious Communication Online Course? What kind of help do you think your relationship needs?

Are you looking for an in-person or online Couples Coaching session or series of sessions? What dates are you available? (In-person single-sessions and intensives are available in Panton, Vermont, depending on Miles' travel schedule.)

Do you have any questions for Miles that will assist you in determining this work is right for you?

Thank you for completing our intake form.

Intake Form for Couples Coaching Conscious Communication Sessions & Intensives For your privacy, your answers are held in strict confidentiality.

Intake Form for Couples Coaching
Conscious Communication Sessions & Intensives
For your privacy, your answers are held in strict confidentiality.