Strengthening Bonds Through Compassionate Counseling Empowering couples to communicate better and thrive together First Name *Email Address *Phone NumberWhat is your gender identity?ManWomanHow old are you? *What is your relationship status?In a relationshipSingleMarriedDivorcedWidowedOtherHow important is religion in your life?Very importantImportantSomewhat importantNot important at allWhich religion do you identify with?ChristianityIslamJudaismOtherWould you like to be matched with a therapist who provides Christian-based therapy?YesNoDo you consider yourself to be spiritual?YesNoHave you ever been in therapy before?YesNoWhat led you to consider therapy today?I've been feeling depressedI feel anxious and overwhelmedMy mood is interfering with my job/school performanceI struggle with building or maintaining relationshipsI can't find purpose and meaning in my lifeI am grievingI have experienced traumaI need to talk through a specific challengeI want to gain self confidenceI want to improve myself but I don't know where to startRecommended to me (friend, family, doctor)Just exploringOtherWhat are your expectations from your therapist? A therapist who...ListensExplores my pastTeaches me new skillsChallenges my beliefsAssigns me homeworkGuides me to set goalsProactively checks in with meOtherI don't knowHow would you rate your current physical health?GoodFairPoorPeferred DatePreferred TimeHoursMinutesAMPMSpecial RequestSubmit Appointment
