Please complete and submit the following information.
Please answer the following questions as completely and accurately as possible
Are you currently seeing a professional therapist on a regular basis? How long? How frequently? Please indicate if current counseling is with a pastor, lay counselor, group, or anyone other than a professional therapist.
What is prompting you to attend Reclaim?
Overall, what do you hope to receive as a result of your participation in Reclaim?
Is there anything else you would like us to know/be aware of in considering your attendance?
2 + 3 = ?