Registration for Group

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Thank you for the opportunity to work with you and your partner! Please give us 24 business hours to respond to your submission.

Email *

Personal Information

Name of person completing the referral *

Spouse/Partner/Significant Other *

Client's Pronouns *

Partner's Pronouns *

Phone Number *

Address *

Client's Zip Code *

Have you ever been in couples counseling/therapy? *

Yes

If yes, when and for how long?

What are you hoping to get out of this group? *

Firefighters and their spouses often face unique relationship issues due to the demands of the job. In a later session, we will address these issues and attempt to work through them. To get the most out of that session, please check all that apply to your relationship.

Not having enough family or couple time

Not having enough alone time

Being closed off or emotionally distant

Feeling guilty about being away from spouse or family

Lack of agreement about helping with kids

Lack of agreement about helping with household tasks

Insecurities about partner spending so much time with the opposite gender at work

Lack of understanding- “She/He just doesn’t get it.”

Worries about safety while at work

Lack of sleep/often being tired at home

Mental health concerns- anxiety, depression, PTSD, etc.

Communication difficulties (please specify):__________________________________________

Other:

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