Meredith Silversmith, LMFT

Licensed Marriage and family therapist
co-founder | clinical director

I’m asking both you and your partner to complete this questionnaire prior to our first session. It will help me show up with a better understanding of where you’re each coming from, what you’re needing, and what is most important to each of you. Please be as open and detailed as you can. Also, keep in mind, it’s my responsibility to be neutral and objective in our work together - so, don’t share anything with me here that can’t be shared with your partner in our sessions. I can’t be privy to any secrets in my work with couples.

Name

First Name

Last Name

What has led you to pursue couples therapy at this time?

What are the 3 most important changes you wish to see in your relationship through his process?

Thinking back, when do you believe the shift to things not feeling so good occurred?

We all play a role in our relationship dynamics. Thinking only of yourself, in what ways do you feel you've contributed to the challenges you're facing together now?

Can you give me the timeline of important events in your relationship?

For example, when you moved in together, got engaged, got married, had your child(ren), experienced the loss of a loved one.

Is there anything else you feel it's important for me to know right off the bat?

Meredith Silversmith, LMFT

Licensed Marriage and family therapistco-founder | clinical director

BUSINESS HOURS

Licensed Marriage and family therapist
co-founder | clinical director