Couples Intensive Application
With Roma Williams, LMFT-S
Full Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Name Of Spouse/Partner
*
First Name
Last Name
Email of Spouse/Partner
*
example@example.com
What State Do you live in?
*
Have you attended couples therapy? (4 or more sessions?)
*
Yes
No
If yes to above, What helped? What did not help?
Is there any active affairs? Or Newly discovered affairs (within the last 30 days)
*
What do you hope a couples intensive could do for your relationship?
*
If we were advised to invest mid 4 figures AND over 15 hours to change our relationship, we would....
*
Please Select
Be confident that I need this service
Be a bit cautious, but willing to make the investment to get the love experience we desire
Avoid this as we need strategies as cheaply as possible
When would you like to start Couples Intensives
*
Please Select
In 30-120 days
6 months or more
Not interested in intensive sessions
The next step is a 30-minute consultation with the therapist. If deemed appropriate, are you open to having an extended consultation for a fee of up to $200?
*
Please Select
Yes
No
Possibly, but contact me first
How did you hear about the couples intensive?
*
Please Select
Facebook
Instagram
TikTok
Unload It Therapy Website / Client (past or present)
Youtube
Word Of Mouth
Next Steps
After you hit submit, you will have access to my calendar for our 30-minute consultation. Please keep in mind that you both will need to be in the same place for the consultation. If for some reason this is not feasible, an exception can be made given the options below. If none of these are a good fit, please email us at hello@unloadittherapy.com with the subject line "Intensive Consult exception."
Approvals for why you will not be together during the consultation
Partners do not live in the same area but will be together during the intensive
Partner is away for work, but will be together for the intensive
Submit My Interest Form
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