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OPEN 7 DAYS A WEEK 9AM-9PM
1-800-913-9613
Specializing in Couples and Sex Therapy
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For Clients
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For Professionals
Houston Relationship Therapy- Dr. Viviana Coles & Associates
Couples Therapy, Sex Therapy, Premarital Counseling
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Our Team
Services
Rates
Request an Appointment
Location
Heights
Offices for Rent
FAQs
Blog
Client Satisfaction Survey
Client Satisfaction Survey
Congratulations on completing our premarital program! To receive your certificate, please complete this form. Once completed, we will email you your certificate to you.
Name
*
First
Last
We will only used the information you provide for training purposes. Please indicate if you would prefer to remain "anonymous".
Email
Date
Date Format: MM slash DD slash YYYY
Your Therapist's Name:
*
Dr. Viviana Coles
Jennifer "Jen" Reeves
Adrienne Brown
Hendrix Scott
Raquel Pereira
Taylor Cordell
Chelsea Koutroulis
Virginia "Ginny" Piletere
Vanessa Oliva
Yonairy Blanco
Sloane Snyder
How many sessions did you attend (estimate)?
*
1-2
3-6
7-12
13 or more
Which option BEST describes your experience at HRT?
*
I was very satisfied with the quality of the services I received.
I was disappointed in the quality of the services I received.
I was satisfied with the quality of services I received.
Please note that this is about the QUALITY of the services you received by your therapist, regardless of the outcome of your therapy sessions.
Please tell us why you chose the option above:
*
Would you recommend HRT to others?
*
Yes
No
I would but I am a private person and wouldn't want anyone to know I sought therapy.
Your Testimonial (optional but greatly appreciated):
Much like you, most potential clients appreciate hearing about others' experiences at HRT. Please share a brief (or long) testimonial about your experience and we may share it on our website without your full names attached. Thanks in advance.
Permission to publish your Testimonial:
*
I permit my testimonial to be used in promotional materials (print/digital) including my initials.
I permit my testimonial to be used in promotional materials but would like to be listed as “Anonymous”
I do not wish to have my testimonial used in any promotional materials (digital/print)
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Comments
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