Couples Coaching Intake Form - Barbara Baumgardner 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling out the 'Referred By' section. Indicate how you were referred and provide your name, phone number, and address.
3. In the 'Patient Identification' section, enter your personal details including name, gender, date of birth, and contact information. Ensure accuracy for effective communication.
4. Complete the 'Spouse or Partner Information' section with similar details about your partner. This helps in understanding both partners' backgrounds.
5. Proceed to the 'Mental Health History and Diagnosis' section. Answer questions regarding past diagnoses and treatments honestly to provide a comprehensive view of your mental health history.
6. Fill out the 'Current Psychiatric Medications' and 'Medical History' sections thoroughly. This information is crucial for tailored coaching.
7. Finally, reflect on your relationship status and goals in the 'Couple’s Focus' section. Articulate what you hope to achieve through coaching.

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