Summer Couples Clinic Registration

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* 1. Thank you for your interest in the Couples Clinic at Regent University.  It is now the summer for the Couples Clinic which means that we are closed to new cases until the end of August.

If you would like to be contacted for an opening in August, please leave your information here and we will contact you.

We occasionally send e-mail updates on services provided or upcoming workshops but only a few times a year and we never sell your information to others.

What is your name?

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* 2. What is your e-mail address? (give a personal email, not a work-email for additional security)

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* 3. Best phone number to reach you?

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* 4. What is your preferred time/s to meet with a counselor? 

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* 5. Are there any restrictions we should know about contacting you? For instance is it OK to call or email at any time?

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