Couples Counseling Initial Intake Form

Please fill out this form privately. A copy shall be emailed to you.

 Please note that you will be asked to talk about your answers in sessions but your partner will not be shown this form, unless you disclose it to them after.

    

Thank you for completing this form. Please note that you will be asked to talk about your answers in sessions but your partner will not be shown this form, unless you disclose it to them after.