Register for 9 Week Process for Personal Change

Registration: All responses are confidential

First Name

Last Name

Phone

Address

Apt, suite, etc.

City

State

ZIP code

Date(s) for which you are registering

Current therapist, if any:

Number of people planning to attend:

Process Contract & Cost Sheet

Please download the PDF of Client Contract and Cost Sheet, print, fill-in info, email the completed form, and pay $500 deposit. How to pay.

How did you hear about us?

When you have registered we will send you detailed location or Zoom information.

If you have any questions filling out this request, please call Elaine Baskin at 650.494.0255.

We will be in touch soon!

We never distribute our mailing list to anyone.