Bridge Project Couples Data

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* 1. What is your street name that you and your partner live on. If not cohabiting please list both. (this is crucial as its used to match with your partner and your therapist while still being confidential data). To complete these questions you should have completed the consent to participate in this study online or on paper with your therapist.

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* 2. Your therapists name

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* 3. Date of your couples therapy SESSION with your therapist

Date

Date

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* 4. My gender is

male

female

Other (please specify)

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* 5. Your age (a double check to match data)

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* 6. When is this survey being taken?

Before session

After session

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* 7. Is this session

Your first session participating in the research

Session 2, 3, 4, or 5

Session 6

Session 7 or later