AZ Registration — Steven W Shields

Hope

August 14-16, 2024

Registration

You can sign up for just one part of the workshop or all 3. If you are signing up for the Boudaries group experience or Individual work you will have a half-hour intro video call with Steven. This is included in the price and will take place prior to the workshop.

Name

First Name

Last Name

Age

Phone

(###)

###

####

Which parts of the workshop are you registering for?

Preferred Method of Contact

Are you currently seeing a therapist or counselor?

Yes

If yes, who is your current counselor and how long have you been in treatment with them?

We will not contact your current counselor without your written consent. However, we do like to work with them as a team for your recovery and will potentially ask your permission to contact them.

Anxiety Level of Coming to Group

What are your goal(s) for participating in this group?

These can be specific or general. We just want to know what your hoping to get out of this group and what you currently need in your recovery process.

Anything else you'd like us to know about you? concerns or questions?

Anything you share here will be kept confidential.