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* 1. Name/Preferred contact number:

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* 2. Describe the state of your relationship in a few sentences. How are you and your partner doing right now?

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* 3. How long have you been together, and how did you meet?

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* 4. What is the primary reason you are interested in therapy? What do you need out of your relationship?

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* 5. What three things are most important to you in an ideal relationship?

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* 6. What benefits would you and your partner see if these needs were met? How would this impact your lives?

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* 7. Have you tried counseling, books, or other resources before? If so, what have you tried?

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* 8. What challenges or struggles come up regularly in your relationship? Is there a fight that you seem to “keep having” and can’t resolve?

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* 9. What would you like to see happen after working on your relationship in therapy? What goals do you have for your relationship?

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* 10. How will your life be different when these goals are met?

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