Christian Couples Contact Page

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What are you interested in?* This field is required.
Couples Counseling
Couples Retreat
Individual Counseling
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Check COUPLES topics of interest:
Communication
Emotional intimacy
Sexual intimacy
Premarital counseling
Discernment counseling
Affair recovery
Parenting
Boundaries
Anger management
Financial stressors
Autism & Marriage
ADHD & Marriage
3
Check INDIVIDUAL topics of interest:
Self-Esteem
Communication
Trust
Emotional regulation
Sexual intimacy
Depression
Anxiety
Parenting
Trauma Recovery
Grief and loss
Autism
ADHD
Other (please specify in background section)
4
Check PARENTING topics of interest:
Stress & burnout
Different parenting styles
Behavioral challenges
Discipline & boundaries
Attachment & bonding
Emotional regulation
Co-parenting issues
Grief and loss
Autism
ADHD
Other (please specify in background section)
5
Check SEX-RELATED topics of interest:
Communication barriers
Mismatched libido
Sexual trauma
Shame & guilt
Performance anxiety
Erectile dysfunction
Painful intercourse
Affair recovery
Other (please specify in background section)
6
Where do you live? (This helps match you with a therapist or coach).* This field is required.
California
Not in California
7
What is your gender identity?Optional
Prefer not to say
Female
Male
Non Binary
Transmasculine
Transfeminine
Agender
Questioning
Other
8
What is your sexual identity?Optional
Prefer not to say
Straight
Gay
Lesbian
Bi or Pan
Queer
Asexual
Questioning
Other
9
Therapist Preferences:
Female
Male
Nonbinary
No gender preference
10
Session fees vary by experience and qualifications. Share what you can pay, and we’ll match you with the right professional.* This field is required.
$300 and up
$250 to $300
$200 to $250
$150 to $200
$100 to $150 - considered "Sliding Scale". Appointments at this price are limited and may not be available.
11
Your Name* This field is required.
First Name
Last Name
12
Your Email* This field is required.
example@example.com
13
Your Phone Number
Please enter a valid phone number.
14
Your Age
15
Partner's NameOptional
First Name
Last Name
16
Partner's EmailOptional
example@example.com
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Partner's Phone NumberOptional
Please enter a valid phone number.
18
Partner's AgeOptional
19
Autism symptoms are presenting for:
Me
My partner
Both of us
Neither of us
One or more children
20
ADHD symptoms are presenting for:
Me
My partner
Both of us
Neither of us
One or more children
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Check ASSESSMENTS that may be of interest:
Autism Assessment - $1,500
ADHD Assessment - $900
Dual Assessment (ASD and ADHD) - $1, 800
Alexithymia Assessment - $300 (as an add on to the Autism or ADHD assessment)
Sensory Assessment - $300 (as an add on to the Autism or ADHD assessment)
PDA Assessment (Pathological Demand Avoidance) - $300 (as an add on to the Autism or ADHD assessment)
Dyslexia Support
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I prefer a therapist with a background that is:
Christian
Spiritual
Muslim
Buddist
Jewish
Agnostic or Atheist
23
Please share any additional backgroundOptional
Huge
Large
Normal
Small
Ok
Ok
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Thank you for sharing your information!

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