CONTACT - GROUPS | Neurodiverse Couples

Please fill out the information below and a group leader within 24 hours.

YOUR First Name

YOUR Last Name

YOUR Phone

YOUR Email

For Couples Groups Only

PARTNER'S First Name

PARTNER'S Last Name

PARTNER'S Phone

PARTNER'S Email

The Group(s) that I am interested in:

Thriving Beyond Cassandra Group

Free "Thriving Beyond Cassandra" Webinar

Where do you reside?

We live IN CALIFORNIA

We live OUTSIDE of CALIFORNIA

Where you live:

Are you currently receiving therapy or coaching from us (NCCC)?

Yes, currently.

No but I did in the past.

No.

My current or past therapist/coach at NCCC is or was:

Please provide as much background as you like:

Information shared on this intake form may be viewed by members of the Neurodiverse Couples Counseling Center staff in order to place you in a group.

By entering your information, you will be added to our mailing list; however, you will be given the option to unsubscribe at any time.

Thanks for submitting! We will contact you within 24 hours