Group Intensive Registration Form | Counseling

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COUNSELING AND BRAIN WELLNESS SERVICES, LLC

Melanie Mahady, LMHC, EMDR Consultant/Education Credit Provider

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First name

Last name

Email

Phone

Address

Preferred Intensive

What draws you to this faith-integrated intensive?

How do you describe your relationship with God or faith background?

How did you hear about us?

I understand this is not a replacement for ongoing therapy or crisis services.”

I have counseling services near me available for ongoing support.

Thank you for inquiring and taking the first brave step in your healing journey. You will receive an email with next steps and a secure payment link.

Counseling and Brain Wellness Services, LLC

The Greenhouse
5301 North Federal Hwy, Suite 399, Boca Raton, FL 33487

©2018 by Counseling and Brain Wellness Services, LLC

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