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Your Marriage Counselor
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Marriage & Couples Counseling
About Dr. Marty Tashman
When It Comes to Relationships Feelings are Everything
Using Cognitive Behavior Therapy (CBT): In Couples & Marriage Counseling
Infidelity
Helping Relationships And Marriages Heal From The Trauma Of Infidelity
Addiction Treatment
Our Services
Intake Form
Jump Start Session
Online Virtual/Counseling
How One Person Can Save A Relationship
Urgent Counseling For Relationship Issues
Bio Feedback Therapy
Decision Therapy
The Relationship Intensive
Radio Shows
Radio Show: Healing From Infidelity Episode 19
Radio Show: Borderline Personality Episode 43
Radio Show: Understanding Your Partner Episode 39
Radio Show: Communication Skills Episode 35
Radio Show: Negotiation Episode 11
Radio Show: Treating Addiction Episode 7
Radio Show: Relationship Expert – Show 40
Radio Show: Dealing With Spousal Depression – Show 41
Radio Show: What is Love? Show 42
Menu
Home
Marriage & Couples Counseling
About Dr. Marty Tashman
When It Comes to Relationships Feelings are Everything
Using Cognitive Behavior Therapy (CBT): In Couples & Marriage Counseling
Infidelity
Helping Relationships And Marriages Heal From The Trauma Of Infidelity
Addiction Treatment
Our Services
Intake Form
Jump Start Session
Online Virtual/Counseling
How One Person Can Save A Relationship
Urgent Counseling For Relationship Issues
Bio Feedback Therapy
Decision Therapy
The Relationship Intensive
Radio Shows
Radio Show: Healing From Infidelity Episode 19
Radio Show: Borderline Personality Episode 43
Radio Show: Understanding Your Partner Episode 39
Radio Show: Communication Skills Episode 35
Radio Show: Negotiation Episode 11
Radio Show: Treating Addiction Episode 7
Radio Show: Relationship Expert – Show 40
Radio Show: Dealing With Spousal Depression – Show 41
Radio Show: What is Love? Show 42
Intake Form
Intake Form
Full Name
Relationship Status
Single
Married
Divorced
Seperated
Cell Phone Number
Work Phone Number
E-mail
Name Of Spouse
Date Of Birth
Spouse Home Phone
Spouse Work Phone
Whom May We Thank for Referring You?
Address
Presenting Problem
Significant Medical History
Are You Currently Taking Any Medication?
Yes
No
If Yes, Name of Medication
Dosage
Prescribed By
Reason
Do You Have Major Medical Insurance?
Yes
No
Insurance ID/Policy Number
Additional Members of Your Household 1 Name
Relationship
AGE
Any Additional Information
Submit