Unstuck & Unshakable™ Relationships

Program Intake

Before We Begin, Let's Understand Your Relationship.

This intake helps Sophia understand your relationship goals, strengths, challenges, and what you hope to gain from the 12 Week Unstuck & Unshakable™ Relationships experience. Please complete it thoughtfully and honestly together.

Safety, Scope and Voluntary Participation

  • This is relationship coaching and education. It is not therapy, counseling, psychiatric care, diagnosis, medical treatment, or legal advice, and it does not create a licensed professional relationship.
  • This website, its forms, and email are not monitored for emergencies.
  • In the United States, call or text 988 for suicide or mental health crisis support and call 911 for an immediate emergency. In Canada, call or text 9-8-8 and call 9-1-1. Outside the United States and Canada, contact your local emergency number, nearest emergency department, or local crisis service.
  • Joint relationship coaching may not be appropriate where there is active violence, threats, coercive control, stalking, intimidation, abuse, retaliation, or an inability to participate freely and safely. In those situations, please contact local emergency, domestic violence, legal, medical, or licensed mental health resources. Please do not describe detailed abuse experiences on these forms.
  • Participation is entirely voluntary and by your own free will. No specific outcome is guaranteed. Review the Terms and Privacy before continuing.
A note on privacy: Please do not include Social Security numbers, financial account information, payment card information, medical records, diagnoses, medication details, or other information that is not needed for this educational relationship program.

Section 1

Couple Information

Preferred contact method*
Relationship status*
Do you currently live together*
Do you have children together or in the household*

Section 2

Why You Are Here

Section 3

Relationship Growth Areas

Select every area you would like to strengthen. You may choose more than one.

Section 4

The H.O.T. Relationship Check In

How would you currently describe the level of honesty in your relationship?*

1 = Needs Significant Work · 5 = Very Strong

How would you currently describe open communication in your relationship?*

1 = Needs Significant Work · 5 = Very Strong

How would you currently describe transparency in your relationship?*

1 = Needs Significant Work · 5 = Very Strong

Which of the three H.O.T. areas feels most important for your relationship right now?*

Section 5

Participation and Readiness

Are both partners willing to participate in the 12 Week program?*
How committed are you as a couple to doing the weekly reflection and relationship work?*

1 = Not Yet Committed · 5 = Fully Committed

Is there any current situation that makes participating in joint relationship education feel unsafe or inappropriate for either partner?*

Section 6

Program Understanding

Please confirm each of the following.*

Section 7

Final Reflection

Your responses are sent securely to Freedom Zone Life Coaching and are not published anywhere on this website.

Investment

$800

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