Transformative Couples Therapy® (TCT) Research Study Interest Form

Thank you for your interest in the TCT Research Study. Please complete this form to begin the process of applying. If there is a possibility of your participation, a member from the TCT Research Team will connect you with a TCT therapist for a free 20-minute consultation call on Zoom.

Name

First Name

Last Name

Names of Couple

Phone

(###)

###

####

Are you referring yourself or are you a clinician referring a couple to the study?

I am referring myself

I am a professional referring a couple

Which state does the couple reside? *At this time, the TCT Research Study is available only to couples who reside in California, Colorado, Connecticut, Kentucky, Maryland, Massachusetts, New York and Virginia.

Are both couple members eighteen or older and have lived together for two years or more?

Yes

Are both couple members eighteen or older and have lived together for two years or more?

How did you hear about the study? And if referred by a clinician, please add their name:

Transformative Couples Therapy® (TCT) Research Study Interest Form

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