Instructions

Your responses to these questions are confidential. I will be the only one reviewing your application. Your answers will not be shared without your permission.

To keep things simple, I've used the term "marriage" to describe your relationship. If you are in a long-term relationship but not married, then consider each question as referring to your committed partnership.


Applications will not be processed until both partners have filled out this online form. I you are the first one to complete the application, please ask your partner to fill theirs out as soon as possible.

Tim Tedder, LMHC, NCC
AffairHealing.com
Currents Counseling Services
 

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1. What is your name (first and last)?

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2. What is the name of your spouse/partner (first and last)?

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3. Contact Phone (optional)

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4. Your Email Address

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5. If you are within driving distance to Orlando, you may opt to schedule a series of 1-Day Retreats (4-6 hour sessions separated by 1-2 weeks) instead of a 3-Day Retreat. Which schedule would you prefer?

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