Building A Lasting Connection™ Workshop Registration

Please complete the following form to begin the registration process.

For Building A Lasting Connection™ Workshop

Your Details(Required)

Your Email Address(Required)

Your Phone(Required)

Your Partner's Details(Required)

Your Partner's Email Address(Required)

Your Partner's Phone(Required)

What is your relationship status? (i.e. Common Law, Engaged, Newly Married, etc)(Required)

Are you currently working with a couples therapist? If so, who?(Required)

What do you find to be most challenging in your relationship currently?(Required)

What do you hope to gain from this workshop?(Required)

Is there any physical abuse in the relationship?(Required)

Yes

Is there addiction or substance abuse in the relationship?(Required)

Yes

Has infidelity been experienced in the relationship?(Required)

Yes

How did you hear about the Building a Lasting Connection retreat?(Required)

93817

RelationSense Counselling

MSW RCSW

1400 Gillespie Rd, Delta, BC V4L 1V9, ca
(604) 644-2392

Hours are by appointment: Days/Evenings/Weekends