Application | Stronger Together

In order to help us better understand your circumstances, please provide the following background information.

First and Last Name

Spouse's First and Last name (if applicable)

Email: You will be emailed a link to your session.

Phone: If you consent to receiving text message about appointments

What specific situation prompted you to reach out for help?

What other methods or help have you tried in the past? (counseling, workshops, podcasts etc.) Write NA if not applicable.

Do you have children?

Will your partner be attending sessions with you?

Yes

No

What religious or spiritual values do you identify with or practice. List separately if different.

What are your 90-120 day goals for your relationship?

improved communication, more time together, more frequent sex, planned date nights, other...

What would it mean to you to see these goals accomplished in 90-120 days?