Couple Therapy Policy: Limited Secrets Policy

Monarch Therapeutic Services, LLC

Relationship Counseling Forms
~ Limited Secrets Policy ~
Please complete and return the form below prior to the intake session.
Each partner in the relationship who will participate in therapy is
required to complete their own set of intake forms PRIOR to the first session.

Couple's Therapy: Limited Secrets Policy

* Indicates required field

Your Name *

First

Last

Because you engaged my services to help you and your partner address problems in your relationship it is important for you to understand what I believe about my role as your relationship/marriage counselor.
~ I do not have preconceived notions about whether you should stay together or part ways.
~ I believe it is important to explore questions about goals for your relationship openly, honestly, and thoroughly.
~ Once your goals are established, I will work diligently to support you in achieving them, whatever they may be.
~ Your couplehood is my identified client. The partners in the couplehood are each treated without preference or prejudice.
~ You are entrusting me to use my professional judgment as it relates to individual confidences.
~ Anything that you communicate to me individually by phone/text, email, or any other means may be important to bring up and work on in couple's session.
~ Out of respect for the trust established in the therapeutic alliance, I will always communicate with you when I feel it is important to bring such disclosures into couple's session and we will prepare how to do so.
By entering your name and date below and submitting this form you are acknowledging agreement of the above policies and that I reserve the right (but not the obligation) address disclosures that were made individually in the couple's session.

Enter Your Full Legal Name Here *

Date *

Submit

CONTACT

LOCATIONS & HOURS

SCHEDULING

OFFICE PHONE: 203.587.8650
OFFICE FAX: 866.881.6464

EMAIL: monarchpsychotherapy@gmail.com

MAILING ADDRESS:
PO Box 8101, Manchester CT 06040

NORTH HAVEN, CONNECTICUT
410 State Street, 2nd Floor left, Office #8

ADMINISTRATIVE HOURS
The office manager is available to receive and respond to calls, messages, texts, emails, and faxes
Monday - Thursday 10am - 6pm EST

CLINICAL HOURS (by appointment only)
IN-OFFICE
Wednesday 9:00am - 7pm EST
Thursday 9:00am - 7pm EST

TELEHEALTH (by appointment only)
Wednesday 8:00am EST - 8pm EST
Thursday 8:00am EST - 8pm EST

3 options to schedule appointments:
> Click button below
> Call schedule line at: 203.405.0837
> Text schedule line at: 203.405.0837

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Couple's Therapy: Limited Secrets Policy

CONTACT

LOCATIONS & HOURS

SCHEDULING