Application

Select a session:

April 10 - May 15, 2024June 12- Jully 17, 2024August 14 - September 18, 2024

Name

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Email

example@example.com

Phone Number

Please enter a valid phone number.

Are you 18 years or older?

YesNo

Have you been unjustly treated by another person?

YesNo

First name of the person who hurt you?

Briefly describe the event that caused you harm.

Have you been in therapy for this issue?

YesNo

Are you currently working with a therapist?

YesNo

Have you experienced symptoms of anxiety or depression?

YesNo

Do you have a diagnosed mental health condition?

YesNo

Are you on medication?

YesNo

Disclaimer: Lisa Rickert, MSSW, facilitator for Heal the Heart Forgiveness Practice, is not a psychologist and does not provide psychological counseling or treatment. While participating in forgiveness group work if you feel you are in need of psychological services contact your therapist. If you do not have a therapist a referral will be provided to you.

Applicants will be notified of acceptance to the group by email. Upon acceptance into the group participants will be sent an email with the payment options: Paypal or personal check.

Cost of the 6-week session: $229.00