Couples: Initial Inquiry

Before we can get started…please fill out the form below (the more you can share, the better)

Once you have been screened, I will contact you to set up the initial meet and greet.

Please indicate how you would like to be screened. When I get back to you, I may request more information.

New to couples sessions with me? Read how it works first.

Step 1 of 4: Partner 1

Partner 1 (required)

Partner to be screened

First NameLast Name

Email (required)

Phone

City and State of residence

Education level, Occupation, and Age

Ethnicity and Gender Identification

Step 2 of 4: Partner 2

Partner 2 (required)

First NameLast Name

Ethnicity and Gender Identification

Education level, Occupation, and Age

Step 3 of 4: You two

Relationship Status

Tell me a bit about you and your partner (required)

Describe your relationship (required)

What are your intentions for our time together and what are you hoping to get out of this experience?? (required)

Step 4 of 4: Screening & meet and greet

How would you like to be screened? (required)

I will ask for your references if that is your preference.

Personal Information Provider References (2 Required)

Photo verification linkA LinkedIn or social media profile works well, or any link to a photo of you. No link? Upload a photo below instead.

Or upload a photoUp to 3 photos. They're locked along with your answers, so only I can see them.

Preferred Date and Time Range Available for Meet and Greet (required)

For the meet and greet we would like to meet (required)

Choose any that work for you.

In person at a public location Virtually: video call Virtually: phone call Virtually: email conversation