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Couples Intake Form

Prior to your first appointment, please complete the following Intake Form.

The information will be submitted electronically using encryption and will remain confidential, and not be shared with anyone without your written consent.

Abma Counselling Services 

Couples CPR Intake Form

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To assist me in helping you, please fill out this form as fully and openly as possible. Your answers will help plan a course of couples therapy that is most suitable for you and your partner. If certain questions do not apply to you or you do not want to share this information, please leave them blank.