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Butterfly Counseling
“What the caterpillar calls the end of the world; the master calls a butterfly.”
First name
Last name
Email
Phone
Multi-line address
Country/Region
Address
City
Zip / Postal code
Which Guided Transformation Program Interests You?
Bloom Essentials
Bloom Signature
Bloom Intensive
Group Transformation Program
The Butterfly Marriage Method™
I'm Not Sure – Please Help Me Choose
Which Transformation Guide Interests You?
Illuminate™: A Christian Shadow Work Experience
The Butterfly After Goodbye™
Growing Through Grief
Boundaries That Bloom™
Emotional Maturity
Teen Transformation
Child Transformation
Menopause & Perimenopause
Peace in the Process
Pray. Breathe. Heal.
What inspired you to seek a Guided Transformation Program at this time?
What are you hoping to gain from this experience?
What challenges are you currently experiencing?
Have you previously participated in counseling?
Yes
No
Are you currently working with another therapist?
Yes
No
Have you participated in one of our Guided Transformation Programs before?
Yes
No
How did you hear about Butterfly Counseling?
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Preferred Start Time
*
As Soon As Possible
Within the Next 30 Days
Within the Next 60 Days
Program Acknowledgment I understand that:
Completion of this form does not guarantee enrollment in a Guided Transformation Program.
Guided Transformation Programs are self-pay services.
Payment in full is required before my first Transformation Day is scheduled.
A three-payment enrollment option may be available; however, the full program investment must be paid before the program begins.
I may be contacted to discuss my goals and determine whether this program is the best fit for my needs.
By submitting this form, I acknowledge that the information provided is accurate to the best of my knowledge and that I understand this form is an inquiry for enrollment into a Cocoon to Bloom™ Guided Transformation Program.
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Begin My Transformation
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