Self-Trust in Relationships — Cohort Application
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Schedule preference
*
Thursdays at 5pm PST (July 9, 16, 23, 30)
Saturdays at 10am PST (July 11, 18, 25, Aug 1)
Either works for me
What's bringing you to this group right now?
*
A few sentences is enough. What's happening in your relationships that's making this feel like the right next step?
Have you done any personal growth, coaching, or therapy work before?
*
Yes, actively ongoing
Yes, in the past
No, this would be my first time
Are you currently working with a therapist or mental health provider? (No judgment either way — this helps me understand your current support system)
*
Yes
No
I was recently but am no longer
This container asks something real of you. Four weeks. Four sessions. Each one builds on the last — and the group holds the space together. When someone is absent, the container shifts for everyone. I ask that you come to all four sessions, show up present, and do the between-session work. Not because it's a rule, but because you deserve the full experience — and so does everyone else in the room.
Tell me a little about where you are right now and what you're hoping this container will give you.
*
Is there anything that might prevent you from attending all four sessions?
Are you currently experiencing any of the following? (This information is kept confidential and used only to assess fit for this group)
*
Active suicidal thoughts or urges to harm yourself
Active thoughts of harming others
Symptoms of psychosis (hearing voices, seeingthings others don't, beliefs out of touch with shared reality)
A current acute mental health crisis
None of the above
Have you experienced a significant trauma or loss in the last 3 months?
*
Yes
No
Is there anything else you'd like me to know about your current mental or emotional state?
Anything you share is held in confidence.
How did you find out about this group?
*
Instagram
Email list
Referral from someone I know
Website
Other
Is there anything you want to ask me before submitting?
I'll respond before confirming your spot.
Refund Policy: Full refund if requested in writing 7 or more days before the first session. 50% refund if requested in writing between 3 and 6 days before the first session. No refund if requested within 48 hours of the first session or after the program begins. Spot transfers to a future cohort are available if requested in writing at least 48 hours before the first session. For hardship or emergency exceptions, contact info@nancydeandrade.com. All requests must be sent to info@nancydeandrade.com.
I have read and agree to the refund policy.
*
I have read and agree to the refund policy.
Send my application
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