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Gottman Couples Counseling
Gottman Couples Counseling is an evidence based treatment for the improvement of marriages and has shown through research to be effective for most couples who wish to remain in a long term relationship. As a treatment specialty, Gottman's counseling requires significant additional professional training above and beyond that of licensure. Our clinicians have undergone training to provide this treatment.

Completion of this form does not guarantee immediate placement of services. However, by completing this form you consent to receive phone calls, text messages, emails, and voicemails from A New Leaf Therapeutic Services PLLC. 
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This counseling accepts private pay only as typically insurances do not cover couples counseling. The cost for a 2 day intensive, 11 hour couples counseling marathon is $2,500. A $200 deposit is required for scheduling and this remaining balance is due at the time of appointment and includes all materials.  *
First and Last Name of Partner 1:  *
First and Last Name of Partner 2:  *
Primary Language *
Required
Referral Source *
ADA Accommodations Needed
Home Address

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Partner 1 Date of Birth *
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Partner 2 Date of Birth *
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Phone Number *
Email Address *
Both members of the couple must be 18 years of age or older to participate. *
Sessions take place on Thurs/Friday. Thursday Schedule: 9am-12pm (Lunch Break) 1pm-4pm. Friday Schedule: 9am-12pm (Lunch Break) 1pm-3pm. *
Presenting Problem (Please provide a brief description of why you are seeking couples counseling). *
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