Application of Interest for Individual Intensives

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Thank you for your interest in our individual intensive programs.

We believe intensive counseling and coaching experiences can be incredibly powerful in laying a strong foundation for recovery and healing. However, intensives are not the right fit for everyone.

At Daring Ventures, we are committed to providing an experience that is right for you. We don’t use a formulaic or one-size-fits-all approach. Instead, we design each intensive with your specific needs in mind shaped by a thorough intake and assessment process.

To ensure the best possible experience, we carefully screen all applicants before moving forward. Completing this form is the first step in co-creating your intensive.

Once the form is submitted, you’ll be able to schedule your 20-minute consultation directly from the confirmation page.

Your responses on this form are confidential, and your honesty gives us the best chance of offering the support you truly need. We look forward to the possibility of walking with you on your healing journey.

To help us manage the growing number of inquiries and maintain the quality of care we provide, a $20 non-refundable administrative fee is required at the time of booking your consultation call.

Email *

Name First & Last *

How old are you? *

You are:

Male

Female

Phone Number *

You are (select all that apply): *

Married

Single

Engaged

Divorced

Separated

Required

Where do you live? *

Are you currently a client of Daring Ventures? *

Yes

If yes, who are you working with?

Please list all children and their ages. *

What is your current living situation? *

What type of individual intensive are you seeking? Check all that apply. (Please note: Dr. Jake Porter does not conduct individual intensives, except for psychedelic-assisted psychotherapy.) *

Betrayal Trauma

Sex Addiction Recovery

Trauma (Eye Movement Desensitization Reprocessing) EMDR

DBT

RODBT

Neurotherapy (In collaboration with Houston Neurosolutions)

Empathy work

Assessment

Coherence Therapy

Brainspotting

Family of Origin

My therapist is referring me for additional assessments only

I don't know

Psychedelic-Assisted Psychotherapy

Other:

Required

Have you undergone a formal therapeutic full disclosure, facilitated by a professional experienced in the disclosure process?
*

Yes

Maybe

If yes, did your disclosure include the use of a therapeutic polygraph? *

Yes

Have not had a disclosure

Are you currently under the care of another helping professional (therapist, coach, counselor)? If so, who? Please include name, email, and phone number. *

Please provide a summary of what brings you to the point of applying for an intensive. Give enough background and detail to give a clear picture of your current situation and needs. *

Where did you grow up? Describe the atmosphere of the home in which you grew up. *

How many times have you or your partner been the plaintiff or defendant in a lawsuit? *

Are you currently experiencing any suicidal or homicidal thoughts? *

Yes

Maybe

Is there anything else you believe we need to know?

How did you first hear about Daring Ventures or Dr. Jake? *

Google search (or other internet search engine)

Podcast

Referred by current Therapist or Coach

Social Media Platform

YouTube

Friend

Other:

If your initial introduction to Daring Ventures or Dr. Jake was through a podcast, could you please specify which podcast it was?

If applicable, what organization, therapist or coach may we thank for referring you to us? *

By clicking the box below, you agree to the following: "I understand this application does not ensure that I will be able to have an intensive, but it begins the process of applying for an intensive. I understand that prior to receiving a formal proposal for an intensive experience, I may be required to complete online assessments and undergo intake sessions. I further understand that if it is learned that anything in this application is a misrepresentation of the truth, my intensive could be cancelled with no refund of fees paid up to that point in the development of my custom intensive experience." *

I understand and agree to the above statement.

Are you who you say you are? (Sorry, we have to ask!) *

I certify that I am who I claim to be on this form.

Required

Are you ready to schedule your consultation and pay the $20 application fee? *

Yes

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 Intensive Coordinator, Kathy Reynolds. 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.

Please note: This is not the application for Returning to You. You will find that application here.

If you do not take any other steps than filling out this application the process will stall. Please proceed to book your consultation.

Send me a copy of my responses.

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