Healing Journey Accelerator Application
Share your background, goals, and readiness to join the group program. This is a coaching program, not therapy or a clinical service. Participation does not constitute a therapeutic relationship.
Applicant Information
First Name
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Last Name
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Email Address
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example@example.com
Age
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Location (City/State or Province/Country)
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Program Interest and Readiness
Why are you interested in this group program?
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What best describes your readiness to sign up for this program?
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I am ready to sign up now
I am ready to sign up but I have a few other questions
I am not sure if this is the right program for me but I'm able to make the investment
I am gathering more information about the right kind of support I may need on my healing journey
I am not ready right now but I'm hoping next year
To ensure we respect your time, can you let us know if you’re currently able to invest financially in this program?* (The program total is $6,400 with payment plans available. If this is not something you are ready for, that’s ok, we’ll send some other options your way!)
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Yes
No
Healing Background and Support History
What are you wanting to change in your life and/or where are you feeling stuck?*
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What is your biggest fear about doing this group program?
Describe any prior experience with a practitioner, coach, or therapist, and what was helpful or not helpful. Put N/A if no previous experience.
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To the extent you are comfortable sharing, can you tell me about your childhood trauma history?
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To the extent you are comfortable sharing, can you tell me about any traumas (physical and/or emotional) that have occurred in your adult life?*
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Commitment and Additional Notes
Commitment to investing in my healing process
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Low
1
2
3
4
5
6
7
8
9
High
10
1 is Low, 10 is High
We have two groups to better accommodate the demand. We will do our absolute best to accomodate your 1st choice but due to demand, we only have 14 spots available for each cohort. Which session best meets your schedule and are you most interested in? — 1st Choice
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Group 1 with Dr. Scott Lyons & Dr. Arielle Schwartz
Group 2 with Dr. Scott Lyons
Which session best meets your schedule and are you most interested in? — 2nd Choice
Group 1 with Dr. Scott Lyons & Dr. Arielle Schwartz
Group 2 with Dr. Scott Lyons
Is there anything else you want to share?
Submit Application
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