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Apply For Myself - Beyond Boundaries

Tell us why you have decided to put your energy, time, and resources into yourself.  On a scale of 1-10 how comfortable do you feel in making this shift?

It should take between 10-15 minutes to answer these 10 questions. You'll hear back from us within one business day. 

 

 

Start

Question 1 of 14

Name, age, phone number, email address?

Question 2 of 14

What time zone do you live in?

Question 3 of 14

Tell us what has made you shift toward understanding and feeling better about yourself.

Question 4 of 14

What have you tried in the past  (counseling, 12-step meetings, or something else)?

Question 5 of 14

Why is this the right time to address this problem? 

Question 6 of 14

What outcome are you hoping for?

Question 7 of 14

Why do you think Kim and Campbell are the right people to help you with this? 

Question 8 of 14

What's the biggest factor motivating you to make a change for yourself? 

Question 9 of 14

Are you wanting to start immediately or within a week or two? 

Question 10 of 14

Campbell and Kim typically see Beyond Boundaries clients on Thursdays?  Does this day work for you or do we need to see if we can make another day work for you?

(Select all that apply)
A

Yes

B

No

Question 11 of 14

Anything else we should know? 

Question 12 of 14

Have you had a chance to look over the FAQ's for this program? 

A

Yes

B

No, but I will

C

No, I have all the information I need.

Question 13 of 14

Do you have any questions about the program?

Question 14 of 14

Quick note about our appointment policy:  Because we have a very limited number of spots in this program, we are unable to reschedule missed and late cancellation appointments.  

A

Acknowledged

Confirm and Submit