Name *

First Name

Last Name

Phone

(###)

###

####

I understand that once this application form is submitted and received, I will be emailed a link to complete 2 short additional documents as part of the application process. This includes an intake form and debit/credit card info (which is encrypted). *

Yes

I understand that once these 2 application documents are received and reviewed, I will be charged the fee for the group. I will not be charged for the group if the group facilitator determines that the group is not a good fit for my needs after reviewing all application documents. If this is the case, I will receive email notification from the group facilitator. *

Yes

I understand that once I complete and submit the additional 2 documents, I will receive an email with a link to the online scheduler to schedule the mandatory free 20-minute consult call to see if this group is a good fit for my goals and needs right now. I understand that I will receive a full refund for the group if the group facilitator determines that the group is not a good fit for my needs after the consult call. *

Yes

I understand and consent to the cancellation policy: If I register for the group and then decide to not join the group, I have through August 15 to email or call the group facilitator to let them know that I am cancelling to receive a full refund. No partial or full refunds will be provided for any cancellation requests starting August 16, regardless of the reason. *

Yes

I understand that payment is required upfront for all 6 sessions, and no partial or full refunds will be issued if I miss one or more sessions, regardless of the reason. *

Yes