Marriage Coaching Application; Group/Private

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Psychotherapy Informed Coaching Intake Form

with Carrie Cohen

My Psychotherapy Informed Coaching Program is for individuals or couples who are ready to take full responsibility for the results they long for. It will require intention, time, and commitment. This means coaching is not for everyone, which is why I have created an application process. I want to make sure this is a good fit for you and I can ensure you will get the results you desire.
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Name* This field is required.
First Name
Last Name
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Email* This field is required.
example@example.com
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Phone Number* This field is required.
Please enter a valid phone number.
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How did you hear about me/where did you find me?* This field is required.
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What time zone are you in (for scheduling purposes)?* This field is required.
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What is currently not working in your life and/or marriage?* This field is required.
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What have you tried to address this? (Therapy, talking, books, podcasts, etc)* This field is required.
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What is your main goal for seeking help at this time? What would you like to accomplish in the work with me?* This field is required.
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The investments for my private marriage coaching is $3000/monthly with a 4-6 month commitment. The investment for 1:1 coaching only for you is 2500/monthly w/ a 6 month commitment. Please note that I do not accept insurance (Pay in full discounted rates are available). I also have a group for women only who want to work on their marriages by also working on themselves.* This field is required.
I am interested in private coaching and I have the financial and time resources and understand the value of investing in myself and my marriage.
I am interested in private coaching and I have the financial and time resources and understand the value of investing in myself and my marriage.
I don't have the ability to access resources now for this investment, but please add me to your email list so I can stay updated on lower cost classes and other offerings.
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If you are coming for marriage coaching, please note that you both must be present for the initial consult.* This field is required.
Yes we will both be there
I'm interested in 1:1 for just me.
I'm interested in the Women's only group
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Are you willing and able to dedicate time on a weekly basis to have meetings with me and do the work in between our calls? My private 1:1/marriage program is set up to provide you a comprehensive approach with everything you need, but it will take time and energy.* This field is required.
Yes! We (or I) are ready to start the work now and acknowledge that this is a commitment requiring our time, energy and focus.
I don't know if we (or I) have the space available for this right now.
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Is there anything else that would be helpful for me to know prior to our call?* This field is required.
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More Details

As a practicing psychotherapist for 25 years, specializing in marriage, I've tailored my couples work to give you everything and only what you need in order for the work to be successful without spending years in therapy.

Much more comprehensive than a conventional talk therapy approach with support in between sessions to maintain the momentum, you'll work through your dynamics in a shorter period of time with this kind of immersive experience.

All of my private coaching includes the following:

Weekly calls on zoom to include joint and solo sessions

Personalized Intake process to understand the root cause of your issues & guide the goals and plan of action.

Customized worksheets, videos, resources tailored to the work we are doing to work on in between sessions so that you always know where to put your focus.

Unlimited access to messaging support with me in between calls so that you can work through sticky moments and feel supported every step of the way (I will respond Monday - Thursday). We will have a group message and you will also have a space for solo messaging to work through what's coming up in your inner dialog w/ yourself.

Access to all the classes I host (live and replay) for the duration of our work together at no additional cost.

Thank you for completing this application. I appreciate you taking the time to reflect on your current state and share that with me.

I will be in touch within 24-48 hours to discuss next steps.

All the best,

Carrie
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