Affair Recovery Contact Page

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Have you previously seen a clinician at our practice?* This field is required.This includes any practice within the New Path Family of Therapy Centers
YESNO
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source
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I am here because:* This field is required.Please select all that apply.
I had an affair
I have been betrayed by a loved one
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When did the affair(s) discovery occur?
In the last month
1 to 12 months ago
More than a year ago
I haven't told my partner yet
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Who wants to work on it?
Both of us are willing
I'm willing, but my partner is unsure
My partner's willing, I'm unsure
We're both unsure
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In terms of support, I am seeking:
Couples Counseling
Individual Counseling
Both
An intensive recovery weekend
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Have you spoken to your partner about autism or ADHD?
Yes, we've talked about it a lot
Sort of. We've hinted at it but never directly
I'm afraid to bring it up.
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AUTISM symptoms are presenting for:* This field is required.Please select all that apply.
Me
My partner
Neither of us
One or more children
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ADHD symptoms are presenting for:* This field is required.Please select all that apply.
Me
My partner
Neither of us
One or more children
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In terms of autism/ADHD, we need support with:
Emotional disconnect
Broken communication
Sensory issues (struggle with touch, smells...)
Withdrawals, shutdowns
Time management
Impulsivity
Rejection sensitivity
Struggle with change
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Where do you live? (This impacts whether you are matched with a neuro-informed therapist or coach)* This field is required.
California
Not in California
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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.
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Therapist Preferences:
Female
Male
Nonbinary
No gender preference
Incorporates spirituality/religion
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I prefer a therapist with a background that is:
Christian
Spiritual
Agnostic or Atheist
Jewish
Muslim
Buddist
Other
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What is your gender identity?Optional
Prefer not to say
Female
Male
Non Binary
Transmasculine
Transfeminine
Agender
Questioning
Other
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What is your sexual identity?Optional
Prefer not to say
Straight
Gay
Lesbian
Bi or Pan
Queer
Asexual
Questioning
Other
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Your Name* This field is required.
First Name
Last Name
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Your Email* This field is required.
example@example.com
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Your Phone Number
Please enter a valid phone number.
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Your Age
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Partner's NameOptional
First Name
Last Name
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Partner's EmailOptional
example@example.com
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Partner's Phone NumberOptional
Please enter a valid phone number.
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Partner's AgeOptional
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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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