Name of Couple *

First Name

Last Name

Name of Couple

First Name

Last Name

What best describes your interest in a private couples session? *

We want to spice things up in the bedroom

We are healing after a difficult experience

We want to feel more connected emotionally

We're having difficulty communicating

My partner and I do not share the same desire for intimacy and sex

Have you ever worked with a coach or partaken in couples counseling? *

Yes

Nope