Relationship Coaching Application Form

To apply for relationship coaching with Jordan and Keltie fill out the application form below.

You will be contacted within 3 business days about your application.


1st Session $100 CAD

60 Minute (Online)

Includes Relationship Assessment*

*Filled out prior to session


Subsequent Sessions $80

50 Minute (Online)

Click the button below to start.


Question 1 of 13

How did you hear about our coaching services?

Question 2 of 13

What is a brief history of your relationship?

Question 3 of 13

What are your goals for coaching?

Question 4 of 13

How would you describe your ideal relationship coach?

Question 5 of 13

Explain you and your partners main roles and responsibilities day to day (special relationships, duties, interests).

Question 6 of 13

Have you or your partner ever been coached and/or been in therapy? If so, please describe the experience(s).

Question 7 of 13

What is your relationship status?

Question 8 of 13

What are your occupations?

Question 9 of 13

What are your date of births?

Question 10 of 13

Where are you located? (City, Country)

Question 11 of 13

Contact Phone Number

Question 12 of 13

Email of Partner 1

Question 13 of 13

Email of Partner 2

Confirm and Submit