Relationship

Email Address

What sparked your interest in the particular group?

What would you like to accomplish as a result of attending the group?

Are either of you currently in individual or couples counseling? Please specify.

Have you discussed culture within your relationship before?

What’s a topic that is often discussed in your relationship? (i.e. Finances, traditions, children, etc.)

What previous experience have you had, if any, with group therapy or other support groups? What worked well for you? What difficulties did you have, if any?

What concerns, if any, do you have about participating in this group?

What is the best way to follow up with you?

What else would you like your facilitator to know about you?

Please complete this form in its' entirety. You will hear from your facilitator within 24 hours of completing it.