Confidential Intake Form For Open: A Group Program for Avoidants

If you want to be in my 10-week group program, please fill out this form to the best of your ability. This program requires a serious commitment emotionally, physically, mentally and financially. I am being upfront with how challenging this will be, however you will be rewarded way beyond what you invest in this program! Do everything asked of you and you will experience massive and amazing change.

  • This is for the discovery session.

Once you complete this form, I will email you to schedule a Discovery Session.