🟣COUPLES REPORT CARD REVIEW

You’re almost done. This form helps us prepare your personalized review.

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🟣 Please answer honestly and thoughtfully. This review is for your growth only

🧠 COUPLES REPORT CARD REVIEW

1. BASIC INFO: This form is about being honest and vulnerability and not shame or blame.

Partner 1 Name:

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Partner 2 Name:

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Email Address (where the written review will be sent)

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Relationship Status?

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2: REPORT CARD SUBMISSION:

Have BOTH partners completed their Report Card?

Choose an option below:

Yes

Not yet (Please complete before submitting)

Note: Each partner should complete their report card separately and honestly. This review is based on satisfaction - not performance.

Upload Your Report Cards:

Partner 1 Report Card

Partner 2 Report Card

3: QUICK CONTEXT

In one sentence, what prompted you to request this review right now?

(Example: We keep circling the same issue" / "We want to be proactive" / We're feeling slightly disconnected")

Write your response below...

4. SELF AWARENESS CHECK

Check all that feel true right now:

Select an option below:

We want clarity, not conflict.

We're open to guidance

We want to train together, not point fingers

We're committed to consistency over intensity

5. FOCUS QUESTION

If clarity ware possible in one area, where would you want it?

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6. EXPECTATIONS

What are you hoping this review helps you do?

(Check all that applies)

Understand patterns

Choose the right room to change

Reduce Understandings

Align on next steps

7. IMPORTANT DISCLAIMER

Required Checkbox

I understand this is a coaching insight review, not therapy or mediation.

I agree to approach the feedback with curiosity, not defensiveness.

I understand the goal is direction, not resolution.

Your responses are private and used only to prepare your review.

(Form cannot submit unless all checked)

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