New Client?

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To make sure that San Diego Couple Care is the right fit for you, I need just a little more information about you.

Contact San Diego Couple Care

Name

First Name

Last Name

Email

Phone

(###)

###

####

Which type of therapy are you interested in at this time?

Couple Therapy

Individual Therapy

Are you planning on using insurance?

Yes, Cigna

Yes, Tricare

No, cash pay or out-of-network

Would you (and your partner) be available consistently to meet on M - F between 11:00 AM to 4:00 PM?

Yes

No

Not Sure

What brings you (and your partner) into therapy at this time? (1 - 3 sentences max)

Common reasons for coming into couple therapy include: general communication difficulties/frequent arguments, communication difficulties around a specific topic (e.g. future of the relationship, money, parenting), current or past infidelity, sexual functioning difficulties Please don’t include identifying information about yourself (or your partner) (e.g. full names, date of birth etc.).