Unwanted Sexual Behavior Counseling IntensivesIndividual Intensive Application Form Name * First Name Last Name Email * Address Address 1 Address 2 City State/Province Zip/Postal Code Country Phone (###) ### #### Why do you want to participate in an intensive? What areas of your life and story are you hoping to address?* * Are you currently in counseling? * Yes No No, but I used to No, but I want to If so, with whom, when, and for what duration. Tell us about what you've been working on together. * Have you ever had any official diagnoses for mental/emotional health related concerns? If so, tell us a bit about that. * * Have you ever struggled with self-harm or suicidal thoughts? If so, please describe. * Many of our clients participate in a faith community. Tell us a bit about your faith journey. * Of the available dates of this therapist, which one are you requesting? * The 2025 cost of these Intensives is $3,250.We require a $500 non-refundable deposit to secure the dates. The remainder must be paid 30 days prior to your intensive. Payment plans are offered if needed. * Intensives include 12-15 hours of Storywork counseling, 1 pre-intensive session, and 1 post-intensive session. I would like to discuss a payment plan I am planning to pay in full now Please acknowledge the terms of our cancellation policy. * The deposit for an intensive is non-refundable. If an individual or couple cancels their intensive within 30 days of the intensive date, they will receive a 50% refund of the cost (minus deposit) of their intensive. If they cancel prior to the 30 days, they will receive a full refund (minus deposit). I understand and agree to this policy How did you hear about us and the ReStory Intensives? Please be as specific as possible. * Is there anything else we should know? * Thank you! Our Practice Coordinator will be in touch shortly.
