Couples Group Interest Form

Already know you'd like to book?

You can go straight to our scheduler and select Canaan Best as your therapist — no need to fill out the form first.

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1. Your contact info

So we know how to reach you.

Your name

Partner's name (optional)

Phone number

Email address

Please provide at least a phone number or an email.

Preferred contact method

Phone call Text message Email

Best times to reach you (choose any)

Weekday mornings Weekday afternoons Weekday evenings Weekends

2. About you & your relationship

Helps us recommend the right group and format.

Group format preference

In-person Online Either works

How did you hear about us?

Is either of you currently seeing an individual therapist?

Yes No Prefer to discuss

What's drawing you to a couples group right now? (optional, a sentence or two)

3. Before your call

A couple of practical details, plus a private note if you'd like one.

How are you hoping to handle payment?

Self-pay Insurance / reimbursement Not sure yet

Anything about safety in your relationship you'd like us to know before we call? (optional & confidential)

Your safety matters. You're welcome to leave this blank and discuss it privately on your call — nothing here is monitored in real time. If you are in crisis or in danger right now, please call or text 988 (Suicide & Crisis Lifeline) or call 911.

Anything else you'd like us to know? (optional)

Hope Connection Therapy Co. · This form is reviewed by our team, typically within 1–2 business days.

Already know you'd like to book?

1. Your contact info

2. About you & your relationship

3. Before your call

Almost done!