Couples Weekend Intensive

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*Please have both partners present when answering this form.

Email *

Who will be attending the weekend intensive? *

How long have you been in partnership and what is the structure of your partnership? (married, domestic partner, etc.) *

How did you meet? *

What do you do for fun? *

Please describe previous couples and/or individual therapy you each have had. *

What is your relationship to your family of origin? *

Have you been married or in long-term committed relationships previously? *

On a scale from 1 - 10, what state do you feel your relationship is in? 1 is we're doing well and just want support in our relationship, 5 is middle of the road, and 10 is crisis mode. *

What reasons are you seeking guidance from Duey and Kimberly? *

What issues do you believe you're struggling with? (communication, infidelity, connection, sex) *

Has their been infidelity in your relationship? *

Have you ever done a genogram or family tree? *

Are you both willing to make changes in your life? *

What are you hoping is the outcome from the weekend? *

Are you available to come to Duey and Kimberly's ranch in Golden, CO? This would be in-person only. *

Yes

Filling out this application doesn't necessarily mean that you will be accepted. We will not work with you unless we feel like we all are a good fit. Do you understand? *

Yes

Disclaimer: We are not doing weekly marital counseling, nor if we do an intensive with you, will we continue to see you individually. You may book more weekend intensives. Do you understand? *

Yes

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