Get-Started For Dating Couple Please answer a few question for us, to connect you with the right therapist. Get-Started For Dating Couple Name * Email * Phone * How long have you been together? * Less than 6 months 6 months - 1 year 1-3 years 3-5 years More than 5 years What is your current living situation? * Separate in the same city Separate in different cities Live-in Separate in different countries Have you been in a relationship before? * Yes No What are the key areas you would want to work on? * Communication Past traumatic Experiences Peer relationships Emotional Supports Insecurity Intimacy Trust Work- life balance Stress management Conflict management How would you rate your relationship? * (1 to 2) We are re-evaluating our relationship and would like to work on multiple concerns (3 to 4) We are doing okay but would like to manage our conflicts (5 to 6) We are doing fine but would like to work on several issues (7 to 8) We are doing good but would like to work on specific concerns (9 to 10) We are happy in the relationship but would like to improve in certain ways What could be some of the obstacles that you might face when seeking/ continuing therapy? * Finances Not finding a good therapist Time constraints Unsupportive environment Stigma of Therapy Confused about how therapy works Not motivated to take therapy Others If you are human, leave this field blank. Submit
