I plan to attend counseling:
With My Partner or Family Member
Name of Participating Partner (if applicable)
Participating partner email address
How would you like to receive services?
Open to Both
Please provide a few times you are available for counseling (example: Monday's after 5pm; 7pm would be ideal)
What Is the best way to contact you?
Would you like to receive our best counseling and relationship advice sent to your email?
How did you hear about us?
Briefly describe the issue(s) you would like to work on.
Email and SMS Text Message Risk Acknowledgement and Use Consent
I understand that the use of email and SMS text messages are inherently insecure and thus poses a risk to the security and confidentiality of my protected health information and I consent to have Thrive Couples Counseling therapists and/or office staff communicating with me via email or text message.