Retreat Registration Forms

Stronger Together Survivors Retreat​​​​​​​


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Briefly describe your experience with domestic violence and any present symptoms you are experiencing (ex. anxiety, panic, depression, anger)
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Are you willing to sign a release of information so that we can speak to this provider, in order to coordinate care?
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How would you describe your physical health? (ex. how often do you exercise, do you have any medical issues that exclude you from physical activities)
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admin none 8:00 AM - 8:00 PM 8:00 AM - 8:00 PM 8:00 AM - 8:00 PM 8:00 AM - 8:00 PM 8:00 AM - 8:00 PM Closed Closed Therapist # # #