Group Program Application

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Returning to Love Group Program Application

with Carrie Cohen
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Name* This field is required.
First Name
Last Name
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Email* This field is required.
example@example.com
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Phone Number* This field is required.
Please enter a valid phone number.
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How did you hear about me/where did you find me?* This field is required.
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What time zone are you in (for scheduling purposes)?* This field is required.
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Are you currently in a committed relationship or marriage?* This field is required.RTL is for women in committed relationships they want to stay in.
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Are you currently separated, in active divorce proceedings, or seriously considering ending your relationship?* This field is required.
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In a few sentences, describe what feels difficult about intimacy in your relationship right now.* This field is required.
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When closeness shows up (touch, emotional vulnerability, conflict), what tends to happen in your body?* This field is required.
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Have you previously done therapy, couples therapy, or personal development work? If yes, what has or hasn’t changed?* This field is required.
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Returning to Love is not trauma-processing therapy. Are you currently experiencing any of the following? * This field is required.Active addiction Untreated eating disorder Active suicidality Ongoing domestic violence Severe untreated PTSD
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This work requires consistent participation for four months. Can you commit to: Weekly live sessions? Engaging the practices between sessions? Staying inside the full arc of the program?* This field is required.
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The investment is $5,000 pay-in-full or two payments of $2,597. Are you financially prepared to invest at this level if accepted?* This field is required.
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Why does now feel like the right time to do this work?* This field is required.
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What would feel different in your marriage if this work were successful?* This field is required.
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Is there anything else that would be helpful for me to know prior to our call?* This field is required.
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Thank you for completing this application. I appreciate you taking the time to reflect on your current state and share that with me.

I will be in touch within 24-48 hours to set up our zoom consult

All the best,

Carrie
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