Currently, no dates or times for another group is planned.  Please do not fill out the form until something definite is posted. 

Take time to provide as much information as you can on your application. There is plenty of room to write your responses to the application questions. You can save your work at any point and come back later to finish it.

We want to make sure that you quality and will fit into this social anxiety group treatment therapy, so that you can be on the path to overcoming social anxiety for good.   

This application form is used for our Local Group, 3-Week (International) Group, Individual Appointments, and some other possible situations.  Thus, some questions might not directly apply to the purpose of your usage.  In all cases, still do your best to provide complete answers for your intended purpose.

Application Fee?
In some cases (Local Group and International Group applications) there will be an application fee, and a question on this application.  There is NO need to pay the application fee up front, for those application purposes.  Please DO NOT pay your application fee until directed to do so, after we've reviewed and replied to your submission.  In the case of the Local Group and International Group, we only request the application fee once the full group is confirmed.

At the time of application, you must be through session four (4) of the audio/video series. Please do not fill out this application unless you are working in session four or beyond.
Please type correctly and check your address. This is the only manner in which we can respond to your application.
No P.O boxes