Discernment Questionnaire

Please take a few quiet minutes (plan for 15-20) by yourself to complete this form, at least 48 hours in advance of our first joint discernment session.  Please be sure to read these important notes before getting started:

  • Some of the questions ask how you’re feeling/thinking about your relationship. If your state of mind or heart has been in flux, just select the option that best represents where you are lately, most of the time. 
  • If you are not legally married, just substitute whatever similarly-intentioned phrase feels appropriate for your relationship in the spots where you see the words “marriage” and “divorce”.
  • Please be as honest and thoughtful in your responses as possible, so that I can most effectively support you in navigating this journey with integrity, intention and from your best self. 
  • Your specific responses to these questions (and others I will ask as we proceed) will not be shared with your partner. My role includes providing each of you with general impressions I have of both of you in this process and in the relationship, but details you share with me will be held in confidence.
  • This form does not have the option to save before it’s been submitted, so it will need to be done in a single session. A computer (rather than phone) will likely be easier.

Once I have received a completed questionnaire and intake form from each of you, you’ll receive the scheduling link to book your first discernment coaching session. Thanks for sharing your thoughts with me here. I look forward to getting to know you and meeting soon!

Contact details

Relationship demographics

Relationship details

In answering the questions in this section, please respond with what feels accurate and generally true from where you’re sitting right now. We’ll have plenty of time when we meet to dig into the nuances and inevitable complexities as they are arise in our work together. (That is, don’t stress over it, and just make the choices that will best help me get a sense of your perspective on the relationships strengths and current challenges.)

Health & Wellbeing

Final steps

I understand that the purpose of this discernment coaching/retreat/intensive is clarification about the next steps for my relationship and for enhanced understanding of myself and my relationship, and that the process — while facilitating self-reflection and emotional awareness — is not one of psychotherapy or couples therapy. I understand that the discernment process will include some time together as a couple, and a significant portion of the time will be 1:1 with the practitioner. I understand that relationship and personal growth services do not come with any guarantees, and hold Rachel Zamore, Rachel Zamore LLC, and InnerWell LLC harmless.