WIY Individual Therapy Form

ATTN: Only fill out this form if you specified on the registration form, that you would like an individual therapy session.

I give my permission for the information contained in this application to be used by the team of therapists and caregivers at the “What’s In You” Retreat. By electronically submitting, you are giving your authorization/consent to all of the terms below without a handwritten signature on your completed form.