Application for Returning to You™
Thank you for your interest in our partner retreat program. We believe that intensive counseling experiences can be incredibly powerful and effective in laying a solid foundation for the work of healing. However, intensives are not the right fit for all people.

We are committed to giving our clients the experience that is right for THEM. To provide you the best experience possible, we carefully screen all who are interested in this program. Completing this form is the first step in collaborating on this process.

Once you complete the form, you will be able to schedule your 20 minute consultation call immediately using the link that will be provided on the confirmation page. If you prefer to book the consultation over the phone, please call 855-602-2554 after you submit your application. PLEASE NOTE: This application is only for our Returning to You™ Partner Program. For any other type of intensive inquiry, please call our offices.

The answers provided on this form are confidential, and your honesty in responding give the best hope of getting the help you need. We look forward to the possibility of working with you!

Due to the volume of applications we are receiving, and to ensure we are able to offer the highest quality of service possible, you will be asked to pay a $20.00 non-refundable administrative fee when you book the consultation call. This fee will be credited toward the cost of the program for those who participate.
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Name *
Phone number *
Email address *
Marital status *
If you selected "other," please specify information below.
Why are you interested in the Returning to You Retreat *
What month(s) are you interested in attending?  *
Are you in individual therapy?  *
If you're working with a therapist or coach, please give their name.
What is the length of time in therapy or coaching and frequency of visits? *
Please list any medical conditions. 
Are you taking psychotropic medication? Please list below.  *
Have you ever been hospitalized for a mental health condition?  *
Have you ever been a plaintiff in a lawsuit?  *
Required
If yes, how many times? What did the lawsuit pertain to?
If yes, please explain the nature of the condition and outcome. 
How did you find out about Returning to You?
Next Steps: Booking Consultation
Thank you for taking the time to complete this application. After you submit, you will be able to click our scheduling link to book your 20-minute consultation call with our program director. If you prefer to book your consultation over the phone, please email frontdesk@daringventures.com and someone from our team will contact you. Due to the volume of applications we are receiving, and to ensure we are able to offer the highest quality of service possible, you will be asked to pay a $20.00 non-refundable administrative fee when you book the consultation call. Should you participate in the full program, this $20.00 fee will be credited toward the program cost.
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