Congratulations on taking the first step toward creating the marriage you love!

All information is completely confidential.

I'll review your information and if it looks like a good fit, I'll contact you so you can schedule your complimentary "Love My Marriage" Discovery Session.

Name

First Name

Last Name

Email Address

Phone Number

How long have you been married?

1-3 years

4-10 years

5-15 years

16-25 years

25+

Tell me about your marriage. How do you see your relationship overall?

What are your specific goals for your relationship?

What are the 3 biggest challenges you face in your marriage right now?

What have you done to address those challenges? What's working? What's missing?

Why do you think I might be the right person to help you meet your goals?

PART of my Couples Program involves couples sessions. If you plan on using your health insurance we’ll need to find out if it covers marriage counseling and if I am a participating provider. Please provide the necessary information below and I will contact them to verify your coverage.

DOB

Home Address

Insurance Name

Insurance ID (including Alpha Prefix)

Insurance Phone Number

If it looks like a good fit, I will show you how I can help you strengthen your marriage.