Couples Information Form - Marléne Rose Shaw

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If you are located in Paphos, Cyprus, we can meet in person.

Otherwise sessions will be via Zoom or another video method of your choosing.

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Have you read the information on the webpage? *

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Person 1 Name:*

Person 1 Name:

Person 2 Name:*

Person 2 Name:

Email Address*

Email Address

WhatsApp Phone Number *

WhatsApp Phone Number

What is your time zone? *

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What are the struggles, challenges or concerns in your relationship? *

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What made you decide to make changes at this point in time? *

Write Here

In your own time zone - in the next 7 days when are you available for a free 30 minute call - list at least 3 days and times. *

Write Here

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