9o Days To Breakthrough Application Form

Thank you for your interest in the 90 Days to Breakthrough Package! By submitting this application, you are expressing your interest in signing up for 90 days of unlimited counseling with Bridgett. Not everyone is selected. If you seem to be a good fit you will be contacted to schedule a follow-up appointment and discuss the next steps to get started.

First Name *

Last Name *

Email *

Phone *

What brings you to seek out this service now? Is there something specific, such as a particular event or situation? Be as detailed as you can. *

What do you hope to accomplish in the next 90 days? *

Is there anything specific you are seeking clarity or direction on? *

If at the end of 90 days you can be free of one thing, what would that be? *

In your perspective what is keeping you from receiving the breakthrough you are seeking? *

Are you experiencing any negative patterns, thoughts, habits, or behaviors that are concerning to you or causing you or others harm? and if so, what are they? *

This service is primarily for those who are looking to integrate their Christ-centered faith and understand that true healing and breakthrough comes from God (Father, Jesus, Holy Spirit) alone. Is this something you are looking for?

Yes, I'm looking to integrate my faith in God into my healing process.

I'm not sure, but I'm open to inviting God into the process.

No, I am not wanting to integrate God into my breakthrough.

On a scale of 1 to 5, how clearly do you hear God's voice? (1 - I don't hear God's voice; 5 - I hear God clearly all the time)

Of all three members in the Godhead (Father, Jesus, and Holy Spirit), who do you feel most comfortable with?

Anything else you'd like me to know?

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