Q Page 9 – LUVMYSELF

Have you had couples/family therapy again? *

Yes

No

Do you live with your partner? *

Yes

No

Is there a domestic violence problem in your relationship? *

Yes

No

Sometimes

What is your gender? *

Male

Female

Other

Age *

Are there any preferences for the gender of your therapists? *

Male

Female

No preferences

What made you turn to a psychologist today? *

Couples (for myself and my partner)