Werner Pitzal

Questionnaire to prepare for your Couple Therapy / Coaching

I am delighted that you decided to engage in couple therapy / coaching with me.

I intend to use the time in your first session fully for your personal issue. Therefore I ask you fill out the questionnaire below independently and apart from your partner, and send it to me no later that 3 days before our first appointment.

Thank you.

Yours sincerely,
Werner Pitzal

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All fields are mandatory.
You find the GTC here, and the basic information in the email that confirms our appointment.

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Name *

Address *

Phone *

Email *

Occupation *

Birth Data *

Referral *

Partner *

Relationship since *

Married? *

Children *

Wish for Child *

Couple Therapy / Coaching *

Individual Therapy / Coaching *

Difficulty *

Resources *

Trigger Event *

Getting to know *

The Positive *

Strengths *

Challenges *

Intention

Outcome *

GTC *

I fully read and accept the GTC (www.pitzal.at/agb), and the general information in the email.

Security Test *

Please type the numbers and/or letters displayed here in the space below the words ’Security Test'. You can request a different captcha by clicking on the arrows circle.

Please submit the questionnaire to me by clicking the 'Submit' button. Thank you.

Psychotherapy • Couple Therapy • Coaching

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