Authentically Anchored Interest & Intake Form - Fall 2026 Cohort
Share your details and availability so we can confirm fit and next steps.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Are you available on late Saturday mornings for 4 consecutive weeks?
*
Yes
No
Need to check dates
Location (used to confirm DMV-area fit for in-person)
*
What draws you to this group right now?
*
Have you worked with a therapist or counselor before?
*
Yes
No
Currently in therapy
Are you currently in individual therapy?
*
Yes
No
Investment: $350 due at registration
How did you hear about this group?
*
Please Select
Threads
Instagram
Facebook group
Referral
Other
Anything else you’d like me to know before we connect?
Submit
Should be Empty: