Skip to content
OPEN 7 DAYS A WEEK 9AM-9PM
1-800-913-9613
Specializing in Couples and Sex Therapy
Facebook page opens in new window
Twitter page opens in new window
Instagram page opens in new window
For Clients
|
For Professionals
Houston Relationship Therapy- Dr. Viviana Coles & Associates
Couples, Sex Therapy, Premarital Counseling
Our Team
SERVICES
Rates
Request Appointment
Locations
Heights
Katy
FAQs
Blog
Our Team
SERVICES
Rates
Request Appointment
Locations
Heights
Katy
FAQs
Blog
Online Relationship Assessment
Online Relationship Assessment
First Name
*
Last Name
Email
*
Phone
Country of Residence
*
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Antigua and Barbuda
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Colombia
Comoros
Congo, Democratic Republic of the
Congo, Republic of the
Costa Rica
Côte d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
Gambia
Georgia
Germany
Ghana
Greece
Greenland
Grenada
Guam
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Zealand
Nicaragua
Niger
Nigeria
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Puerto Rico
Qatar
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
Spain
Sri Lanka
Sudan
Sudan, South
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Yemen
Zambia
Zimbabwe
State of Residence
*
Not in the United States
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
Do you live near the Houston-area?
*
Self-Identified Gender
Non-Binary
Male
Female
Prefer not to answer
Relationship Status
*
Single, not dating
Single and Dating Multiple People
Dating Exclusively
Living Together
In a Long Distance Relationship
Engaged
Married
Open or Half Open Relationship
Long-Term Committed Partnership
Separated and Working on Relationship
Divorcing
Divorced
Widowed
Choose the box/boxes that most accurately represent/s you
How did you hear about us?
Google
Bing
Yahoo
Yelp
PsychologyToday.com
Intima Health App
Arow Dating App
99.1 Radio
790am Radio
Houston LIfe TV Show
Married at First Sight TV Show
Previous/Current Client Referred me
My Doctor Referred me
My Lawyer Referred Me
An HRT Therapist
Speaking Engagement
HRT Staff Member Outreach
Facebook
Instagram
Twitter
I am content with how my partner and I communicate in our relationship.
*
True
False
My feelings and opinions are respected by my partner.
*
True
False
My partner and I have clear and agreed upon expectations for each other in our relationship.
*
True
False
I feel satisfied with how my partner expresses love for me.
*
True
False
I am satisfied with the time we spend nurturing our relationship.
*
True
False
I am satisfied with the time we spend nurturing our individual needs.
*
True
False
I am satisfied with the frequency of our sexual activities.
*
True
False
I am satisfied with the quality of our sexual activities.
*
True
False
I am comfortable sharing ideas on how to enhance our sexual intimacy.
*
True
False
My partner and I have compatible spending/saving styles.
*
True
False
I am accepting of my partner’s finances and how they may impact our future.
*
True
False
My partner is accepting of my finances and how they may impact our future.
*
True
False
My partner refrains from using hurtful language when we are in conflict.
*
True
False
I refrain from using hurtful language during conflict with my partner.
*
True
False
We usually resolve conflicts in a satisfactory way for both of us.
*
True
False
My partner and I have discussed our wishes about having children.
*
True
False
My partner and I have compatible value systems.
*
True
False
We have discussed the environment in which we would like to nurture our marriage/raise our children.
*
True
False
CAPTCHA