What are the benefits you're looking to achieve?
Do you prefer to work with a male or a female therapist?
Do you prefer to work with a younger or older therapist?
Do you prefer to work with a more liberal or a conservative therapist?
Sexual Orientation of your Relationship?
Do you currently live with your partner?
Is domestic violence currently an issue in your relationship?
How would you rate your current financial status?
Who referred you to Brain Divine?
Please mark all that apply.