Relationship boot camp

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The Relationship Bootcamp is a two-day workshop for couples and individuals who want to learn the essential skills for more loving, intimate relationships. The weekend is an intimate experience of each other, and it will be one couple per weekend and Jennifer Lovely ONLY.

These questions will help Jennifer Lovely gauge the support needed for your weekend. Please fill out the intake form below and Jennifer Lovely will reach out to complete your registration.

This is an authorized presentation of Terry Real’s Relational Bootcamp, using the skills and principles from his Relational Life Therapy (RLT) model.

Name

First Name

Last Name

Partner's Name

First Name

Last Name

Email

Phone

(###)

###

####

Relationship Status?

Years Committed Relationship?

Mother's Name/Age

Three positives and three negatives adjectives to describe your mother when you were growing up.

Father's Name/Age

Three positives and three negatives adjectives to describe your father when you were growing up?

Describe issues with parents?

Describe any stories you make up about your partner.

Health check list. Tell me about your current health.

Tell me about any mental health struggles you face.

Anxiety - Depression - Substance Use - Anger - Workaholism - Food addictions

Does your partner struggle with any mental health concerns?

If so, tell me more: Anxiety - Depression - Substance Use - Anger - Workaholism - Food addictions, etc....

Name and Ages of Children if applicable.

Provide therapists you are currently working with? Please include if Jennifer is able to contact them for additional support if needed..

Any other comments?

Relationship boot camp

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