Find A Therapist - Hisparadise Therapy

Let's Find You A Therapist

Relationship therapy form

Let's find a therapist for you

- Step 1 of 6

What's Your Name? *

What is your Gender? *

Male
Female

Status

Married
In a relationship
Complicated
Single
Divorce

Please Choose Therapy Type *

Relationship Therapy
Couples Therapy
Individual Therapy
Sex and Intimacy Therapy
Other Therapy

Tell us your therapy type *

What's your sex life like? *

Just okay
Fantastic
Boring
Awful

Are you living with your partner? *

Yes
No
My partner visits sometimes

Have you booked appointment with us before?

Yes
No

Your Email *

Email

Confirm Email

Phone

Is domestic violence currently an issue in your relationship? *

Yes
No
Sometimes

Could these be the reasons why you need counseling? *

Tell us why you need counseling *

Have you ever raised your hand on your partner? *

Yes
Sometimes
Not at all

Has your partner ever raised their hands on you? *

Yes
Sometimes
No

What are you struggling with?

Tell us what you're struggling with

Are you addicted to any of these? *

Alcohol
Gambling
Sex
Past relationships
Masturbation
Smoking
None
Others

What's your addiction? *

Has your partner ever cheated on you?

Are you quick to anger? *

Yes
No
Sometimes
Not sure
My partner is quick to anger, not me

How's your financial status

Good
Okay
Bad

Your preferred Therapist

Male Therapist
Female Therapist
Anyone

How would you like to communicate with your Therapist/Counselor?

What are the benefits you're looking to achieve? *

Describe the benefits you're looking to achieve *

Choose your preferred time *

Morning (Between 9am - 12pm)
Mid-Day (12pm - 3pm)
Afternoon (3pm - 5pm)
Evening (5pm - 7pm)
Night (7pm - 9pm)

Address *

Address Line 1

City

State / Province / Region

Country

What else should we know about your situation? *

How Do You Want To Make Payment?

Take Me To WhatsApp (Recommended)
Continue to Online Payment

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