Relationship Rescue: Counseling Survey Insights

What is the main issue causing distress in your relationship?

Communication Trust Intimacy Conflict resolution External stressors

How long have you been experiencing these challenges?

Less than 6 months 6 months to 1 year 1-3 years Over 3 years Not sure

What efforts have you made to address these issues?

Couples therapy Individual therapy Self-help books Communication exercises None

Are you both willing to work on improving the relationship?

Yes, both are willing I am willing, partner is unsure Partner is willing, I am unsure No, neither are willing Unsure

What do you hope to achieve through counseling?

Improved communication Rebuild trust Enhanced intimacy Conflict resolution Overall relationship satisfaction

Have you considered seeking relationship guidance before?

Yes No

All set, how can we reach you?

Name

Phone

Yes, I have read and agree to the Terms and Conditions. (Details here)

I would also like to receive more information (optional).

Thanks for stopping by!

We will be in touch shortly.

Great, got your response!

Thanks!

Your openness paves the path to relational harmony!