Love Life Transformation Pre-Session Questionnaire

Your privacy is important to me, and I treat all client information as confidential.

To make the most of our time together, you have three choices:

1. Get a head start by completing this questionnaire in advance:

•  Download this form
•  Type your answers
•  Save it
•  Email it to info@drsusanedelman.com (While email isn’t 100% secure, having this information beforehand allows us to dive deeper in our first session)

2. Discuss these questions during our session together instead (This is completely secure but may take up most of our first session)
3. FAX it to me at 650-566-8551.

Either way works well – it’s your choice!

Name:                                                                                                                                                   Date:

Getting Started

1. What inspired you to get support with your love life at this time?

2. What are your top three goals for our work together?

3. How would you describe your current relationship status?

Looking at Patterns

4. When you reflect on your past relationships, do you notice any recurring patterns?

5. What qualities do you consistently look for in a partner?

6. What tends to cause your relationships to end?

Self-Understanding

7. How satisfied are you with your current love life (1-10)? Why?

8. What do you believe are your greatest strengths in relationships?

9. What aspects of relationships do you find most challenging?

Moving Forward

10. What does your ideal relationship look like?

11. What do you believe is currently standing between you and the relationship you want?

12. What changes are you most hoping to make through our work together?

13. Is there anything else you’d like me to know before our first session?

Thank you for sharing your story.
I’m excited to be part of your transformation!

Warmly,
Dr. Susan