Disclaimer: This intake form is optional. These questions are designed to assist clients in organizing their thoughts, not to overwhelm. If the intake proves to be the latter, just show up to your initial appointment and omit this for

General Information

Presenting Issue Information

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Couple's Level of Bonding

Below are all variables that impact couple’s level of bonding. Please briefly describe your feelings, thoughts and/or abilities regarding the following:

Centering Questions