Couples Counseling Initial Intake Form

Couples Counseling Initial Intake Form - Couples Counseling Initial Intake Form Author Kristen Gibson Created Date 9 22 2014 12 40 45 AM

Couples Counseling Initial Intake Form Please note that while you will be asked to talk about your answers in session your partner will not be shown this form Relationship Status check all that apply Married Living Together Separated Living Apart Length of time in current relationship

Couples Counseling Initial Intake Form

Couples Counseling Initial Intake Form

Couples Counseling Initial Intake Form Please note that while you will be asked to talk about your answers in sessions, your partner will not be shown this form. Name: ____________________________________________ Date __________ Phone:________________________________ May I leave a message? Y / N Is it acceptable to email you?

80 00 cancellation fee You are giving Serenity Counseling Center permission to contact you via phone call text or email concerning your appointment case information or other business pertaining to Serenity Counseling Center Legal Our counselors are available for in office depositions at an agreed upon fee

Span Class Result Type

1 What is the problem that led you to decide to come to couples therapy 2 How long have you and your partner been together In what form e g dating living together married 3 What initially attracted you to your partner 4

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Couple Counseling Initial Intake Form Client Name Date Partner s Name Relationship Status Please indicate all that apply Married Separated Divorced Dating Cohabitating Living Together Living Apart Length of time in current relationship Current Concern

Span Class Result Type

Please draw a graph indicating your level of marital satisfaction beginning with when you met your partner Note pivotal events in your relationship Please rate your current level of marital happiness by circling the number which corresponds with your current feelings about the relationship 0 1 A Little Unhappy

Couple s Intake Questionnaire Adrienne Cane Ilang MA MFT

Cbt therapist 424 256 5426 310 943 2489 fax erika cbt therapist 2 Reason for seeking couples therapy at this time Please include the following information 1 What is the presenting issue problem that is bringing you into therapy

General counseling intake Getting started with new clients and structuring the first counseling sessions requires an initial understanding of their background, concerns, and primary thoughts on how and where they require help and support (Cochran & Cochran, 2015).

Span Class Result Type

Birth date Sex Gender Ethnicity Religion Marital status dating married cohabiting separated divorced Number of children Ages of children Home address

Couples Counseling Initial Intake Form

Cbt therapist 424 256 5426 310 943 2489 fax erika cbt therapist 2 Reason for seeking couples therapy at this time Please include the following information 1 What is the presenting issue problem that is bringing you into therapy

Couples Counseling Initial Intake Form Please note that while you will be asked to talk about your answers in session your partner will not be shown this form Relationship Status check all that apply Married Living Together Separated Living Apart Length of time in current relationship

FREE 9 Counseling Intake Forms In PDF Ms Word