New Client Intake Form If this is our first time working together, please fill out this Intake Form so I have your contact information and an overview of the issues. Click SUBMIT at the bottom and your form will be sent directly to me. Please enable JavaScript in your browser to complete this form.Your name *FirstLastPhone number *Phone #Email *Please enter your email, so we can follow up with you.Who is the other person you want to improve communication with? *Romantic partnerRelativeFriendBusiness or work colleagueNeighbor or community memberOtherWhat is the other person's first name? *Has something changed in your relationship, or is this a problem that has build up over time?Something has changedA build up of issuesBriefly describe the communication issues you're having. *What do you want to see changed in this relationship?Submit