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Couples Questionnaire
Contact Us
Name Partner A
Contact Information
Preferred Method of Contact
Phone
Email
Name Partner B
Contact Information
Preferred Method of Contact
Phone
Email
Have you both discussed attending counseling together?
Yes
No
Have you both attended any form of counseling in the past?
Yes
Individual
Marriage
No
If yes, what was the outcome? Briefly describe
What issues or challenges have led you to seek couples counseling? Briefly describe.
What is your goal to achieve through counseling?
Do you have time constraints? If Yes, Describe
Are there any concerns that we should be aware of?
Do you prefer in-person or online?
Have there been proven or accusations of infidelity?
Please be assured that all information shared in counseling sessions is kept confidential, with exceptions only as required by law. Next step: After you submit this inquiry, we will contact you to discuss your situation further and schedule an initial consultation. We appreciate your trust in considering couples counseling as a path to strengthen your relationship.
Thank you for contacting us.
We will get back to you as soon as possible.
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916.295.8582
info@theteamwellness.com
9864 Dino Drive
Elk Grove, Ca 95624
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