Request Appointment

Days and Times of the Week You Can Come to Therapy:

Are you looking for in-person therapy, Telehealth therapy, or both? (Please check all that apply.)
In-personTelehealth
Are you looking for individual, couples, or family/child therapy?
IndividualCouplesFamily/Child
Type of Insurance, If You Have It & Hope to Use It:

What brings you to the Relationship Therapy Center?* (Please check all that apply.)
Affair/BetrayalOn the Brink of Divorce or Discernment CounselingCrisis (please explain below)Learning Basic Skills/Tools to be a Good PartnerCommunication IssuesIncrease in ConflictSexual ConcernsOther (please explain below)

If you selected "Crisis" or "Other" or if there is additional information we should know - please provide the information here:

Who referred you to us?
How did you find us?

If you selected "affair" or "on the brink of divorce" we strongly recommend you check out our Intensive Couples Counseling Program

If you experience any difficulties in using this form please email us at relationshiptherapycenter@gmail.com