Teletherapy Solutions cannot help people in crisis. If you are worried about your or someone else’s safety, click here for resources.
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Teletherapy solutions cannot help people in crisis. If you are
worried about your or someone’s safety, click here for resources.
Teletherapy solutions cannot help people in crisis. If you are worried about your or someone’s safety, click here for resources.
Couples Counseling
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Couples Counseling
Step 1 of 3
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Name
*
First
Last
Date of Birth
*
Date Format: MM slash DD slash YYYY
Age
*
Partner's Name
*
First
Last
Looking for a therapist with specialized knowledge in LGBTQ affirmative therapy?
*
Yes
No
Looking for a counselor with experience incorporating religion and/or spirituality?
*
Yes
No
Looking for a sex-positive counselor, affirming to non-traditional relationships (i.e. polyamory, kink positive, open relationships)
*
Yes
No
What will we be accomplishing together?
*
Improve communication
Decide whether we should separate
Learn to resolve conflicts and disagreements
Overcome adultery
Reconnect
Parenting
Sex and intimacy
Divorce or separation mediation
Now we will be asking some more serious questions. It is important to answer honestly so we can be sure to help find the right therapist for you. Your safety is our top priority.
Is domestic violence currently an issue in your relationship?
*
Yes
No
Do one or both partners currently have a plan to kill or harm yourself or someone else?
*
Yes
No
Do one or both partners engage in self-harm behaviors? (i.e. cutting or burning yourself)
*
Yes
No
Has either partner attempted suicide in the past year?
*
Yes
No
Do one or both partners need substance abuse treatment?
*
Yes
No
Are you seeking treatment that has been mandated by a court?
*
Yes
No
Has either partner been hospitalized for mental health reasons in the past year?
*
Yes
No
Has either partner received care at a residential treatment program in the past year?
*
Yes
No
Phone
This field is for validation purposes and should be left unchanged.
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