top of page

download (5).png

Book Thinking for a Change

346-874-0683

Home
Thinking for a Change Registration Form
Book Thinking for a Change
Make a Payment
Contact Us
Refund And Cancelation Policy
More

Use tab to navigate through the menu items.

COUNSELING CONSENT TO TREAT

To register, please take the time to fill out the information below.

First Name

Last Name

Email

Phone

Birthday

Address

Address Line 2

City

Region/State/Province

Postal/Zip Code

Country

Referral source First Name

Referral source Last Name

Referral source Email

Referral source Phone Number

© 2023 by S. Hinds, MSc, LCDC

bottom of page