ReStory® IntensivesIndividual and Marriage Intensive Application Form Name * First Name Last Name Email * Address Address 1 Address 2 City State/Province Zip/Postal Code Country Phone * (###) ### #### Is this for an individual or marriage intensive? If this is for a marriage, both spouses must complete the application. * Individual Marriage Why do you want to participate in an intensive. What areas of your life and story are you hoping to address?* * Do you feel as if these issues have reached a crisis point? * Yes No If yes, please explain. Are you currently in counseling? * Yes No No, but I used to No, but I want to If so, with whom, when, and for what duration. Tell us about what you've been working on together. Do you have specific diagnoses for mental/emotional health concerns? If so, please list them below. * Have you ever struggled with self-harm or suicidal thoughts? If so, please describe the frequency and severity. * While not a requirement, many of our clients are people of faith. If applicable, please tell us about your faith journey. Which therapist do you prefer? * Chris Bruno Tracy Johnson Jeremy Williamson Of the available dates of this therapist, which one are you requesting? * The cost for a 2025 Intensive is $3,750 for individuals and $4,750 for couples. How do you anticipate handling payment? * Intensives include 15 hours of storywork counseling with ReStory Experts, pre-work and engagement, and 2 post-intensive sessions for re-entry. I plan to secure my dates with a $500 deposit and then set up a payment plan I plan to pay in full upfront Is there anything else you would like us to know? * How did you hear about us and the ReStory Intensives? Please be as specific as possible. * Thank you for your application! We will be in touch shortly.
