Couple Counseling

When we have reached your name on the waitlist we will send you our intake paperwork VIA EMAIL through SIGN NOW the business day following your submission. This paperwork must be completed within 72 hours to move forward with services. Once the intake paperwork is complete we will reach out to schedule an intake appointment. All of our intake appointments are conducted over Zoom and completed between the hours of 10am and 3pm.

*Please only complete this form if you have discussed Couples Counseling with your spouse.*

* Indicates required field

First Name and Last Initial *

Phone Number *

Email *

Military/First Responder Affiliation *

If Active Duty, is the service member stationed at Ft. Campbell? *

If First Responder, is First Responder serving in Montgomery Co? *

Spouse's First Name and Last Initial *

Spouse's Phone *

Spouse's Email (must be different from above email) *

Address *

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City

State

Zip Code

Country

Are you and your spouse living separately or together? *

If living separately please list your spouse's address: *

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Line 2

City

State

Zip Code

Country

Have you or a family member received services with SAFE previously? *

Name of individual who received services previously. *

Soldiers and Families Embraced does not provide counseling for legal purposes or DCS involvement. If you are seeking counseling for either of these reasons SAFE will not be able to provide you services but would be happy to give you resources to other mental health agencies that will.

Do you or your spouse have any open legal cases (including criminal, divorce, custody, etc)? *

Is there DCS involvement? *

Is this counseling court ordered? *

If yes to any, please provide information. *

Submit