Family Histogram Form

I am very much looking forward to doing your histogram with you. It can be such a rich, powerful experience.

Before you start completing the form, be sure to schedule a 90-minute appointment in my calendar. Please give me a minimum of 48 hours between submitting this form and your appointment, so that I have time to draft your histogram.

Schedule appointment

Complete Your Family Info:

In the form below, on any given question, if you don't have any relatives that match the question, write NONE.

For example, if your mother was an only child, under the question asking for your mother's siblings' spouses you will write 'NONE' and also under the question asking for your cousins on your mother's side, you'll write 'NONE'.

Family Histograms Data Gathering

Name

First Name

Last Name

Email Address

Mailing Address

Phone number

Birth date

First generation: Write the names of your FATHER'S PARENTS + the year they were born, and the year they were married.

If they divorced and married other people, write the year they divorced and the names of the new spouses along with the marriage year.

First generation: Write the names of your MOTHER'S PARENTS + the year they were born, and the year they were married.

If they divorced and married other people, write the year they divorced and the names of the new spouses along with the marriage year.

Second generation: Write the names of your FATHER + HIS SIBLINGS + the year they were each born

If there are half-siblings and/or step siblings, specify whose children they are.

Second generation: Write the names of your FATHER'S SIBLINGS' WIVES/HUSBANDS/PARTNERS

Please note to whom they are married and if they got divorced. i.e. Mary (uncle Mike's wife - Divorced)

Second generation: Write the names of your MOTHER + HER SIBLINGS + the year they were each born

If there are half-siblings and/or step siblings, specify whose children they are.

Second generation: Write the names of your MOTHER'S SIBLINGS' WIVES/HUSBANDS/PARTNERS

Please note to whom they are married and if they got divorced. i.e. John (Peter's partner)

Second generation: Write the year of YOUR PARENTS' marriage (or when the relationship started)

If they got divorced or separated, write the year they separated. And if they remarried, write the names of the new spouses and the marriage year.

Third generation: Write the names of all of YOUR SIBLINGS + the year they were each born

If there are half-siblings and/or step siblings, specify whose children they are.

Third generation: Write the names of YOUR SPOUSE/PARTNER + SIBLINGS' PARTNERS + year when you were each married

Note to whom each person is married and if they got divorced. i.e. Steph (Joe's wife. Married 1982. Divorced 1992)

Third generation: Write the names of all of your COUSINS on your FATHER'S SIDE + who their parents are

For example, Mike and Mary's kids: Peter, Paul and Louis.

Third generation: Write the names of all of your COUSINS on your MOTHER'S SIDE + who their parents are

For example, John + Peter's kids: Maia, Eleanor

Fourth generation: Write the names of YOUR KIDS and their date of birth.

Other important members of the family not captured above -- Include here adults, caretakers, distant relatives, etc. who had an important role in the family or in your life even if they weren't related to you.

List their name and explain the relationship in a few words.

Other comments you'd like to make: