Name
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First Name
Last Name
Email Address
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Partner's Name
First Name
Last Name
Whose love did you crave the most: your mother or your father?
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What did you have to be for that person to accept and love you? What did you have to think or do to gain their approval?
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When you were a child, were there any activities that were so interesting to you that they could cause you to lose track of time (you had to be reminded to come home for dinner, go to bed etc.)? Please tell me about them.
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Choose three books that have influenced your life. Why were they important to you? How did they change you?
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Name three of your favorite movies. Why do you like them? How did they change you?
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Are there any activities in which you now participate (as an adult) that cause you to lose track of time? Please tell me about them.
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What’s your favorite form of self-care and/or what do you do to spoil yourself?
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If I could make anything, it would be...
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If I had the money, I would...
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The world would be a better place if...
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If I could change one thing about myself, it would be...
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If I would not hurt anybody’s feelings, I would...
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If I were creative enough, I would...
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If I just had the time, I would...
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If I didn’t have to worry about my other family members, I would...
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If I could do one thing in life that I have not done yet, it would be...
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If I could change one thing in my past, I would...
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Please tell me about three of the best experiences you have ever had.
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Choose three adjectives to describe each of them.
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Now, please tell me about three of the worst experiences that you have ever had.
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Choose three adjectives to describe each of them.
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People judge me because...
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Everybody loves it when I...
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When I do well, others feel...
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If everyone would just leave me alone, I would...
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Others just can’t accept that I...
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When I fail, everybody always thinks...
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People always tell me I should...
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Everyone keeps telling me I have to...
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People expect me to...
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Others always warn me that I shouldn’t...
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What are you ridiculously good at?
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What’s your area of least satisfaction in your life?
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If you had a magic wand, how would your life be different?
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On a scale of 1-10, how fulfilled are you in your current career and why?
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Are you married or involved in a long-term relationship?
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Are you happy with your relationship (or lack thereof)? Tell me about it.
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Has your partner had a semen analysis? If so, what were the results?
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Do you exercise or participate in a physical activity regularly? If so, what and how often?
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Are you happy with your level of physical fitness? Why or why not?
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Do you currently have any PMS symptoms? If so, what are they?
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What is your diet like?
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Is your partner watching their diet and taking care of themselves?
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Have you ever been pregnant before? If yes, please describe.
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Without going into too much detail, describe what doctors have told you about your fertility?
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Describe what do you tell yourself?
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