Soul Dig Book Club: "Beyond Anxiety" Application
"Thank you for your interest in the Beyond Anxiety Guided Book Club Program! This is an 8-week, in-person program designed to help participants move from anxiety into clarity, creativity, and resilience. Please complete this short application so we can ensure this group is the right fit for you.
Pricing
The Program Cost is $700. This fee covers all group sessions, course materials, access to an online member forum, and a comprehensive workbook. COMMUNITY ACCESS FUND: $50 of your program fee helps fund a lower-cost spot for a participant with financial need. By contributing, each participant actively supports a more inclusive space. By continuing with this application, you acknowledge and understand that the full fee program cost is $700 and agree to this fee structure.
There is 1 reduced- fee spot available for this group. Would you like to apply?
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Please Select
Yes
No
Your Details:
Full Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Format: (000) 000-0000.
E-mail
example@example.com
How did you hear about the group?
*
Please Select
Therapist
Maryefortunato.com
Friend
Other
Are you currently receiving therapy or professional mental health support?
*
Please Select
Yes
No
How long have you struggled with anxiety?
*
Please Select
12 months or less
12 months- 3 years
More than 3 years
How do you currently manage anxiety? (select all that apply)
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Therapy
Medication
Mindfulness/meditation
Exercise
Other
The group meets in person for 8 weeks. Are you able to commit to attending sessions?
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Yes
No
The group includes reading and weekly homework. Are you able to commit an hour a week to at-home exercises and reading?
*
Yes
No
What interests you about this group? What are you hoping to gain from participating?
0/50
Do you have any accessibility needs or accommodations we should be aware of?:
0/30
Final Agreement & Submission. Please type your full name to confirm that you understand this group is not a substitute for therapy, and is intended as a complement to professional mental health support.
0/30
Thank you for taking the time to complete this application!
I will respond within 7 days to schedule an intake call, if this group is a good fit. At that time, a $100 deposit will be due to reserve your spot.
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