COUPLES REPORT CARD REVIEW FORM

This form helps us prepare your personalized review.

COUPLES REPORT CARD REVIEW

THIS REVIEW FOCUSES ON HOW YOU ARE SHOWING UP IN YOUR RELATIONSHIP

Partner 1 Name:

Partner 2 Name:

Email Address of Where the Review Will Be Sent To:

Relationship Status

HAVE BOTH PARTNERS COMPLETED THEIR REPORT CARD?

Yes

No

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

UP[0AD YOUR REPORT CARD

Partner 1

Partner 2

IN ONE SENTENCE, WHAT PROMPTEDE YOU TO REQUEST THIS REVIEW RIGHT NOW?

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

CHECK ALL THAT FEEL TRUE

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

WHAT ARE YOU HOPING THIS REVIEW HELPS YOU?

Understand patterns

Choose the right room to change

Replace understandings

Align on next steps

AGREE ON ALL 3 BELOW:

I understand that 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 COMMIT UNLESS ALL CHECKED)