On the Journey Monthly Peer Support Program x4

Name *

First

Last

Email *

Do you currently see a professional counselor? *

Yes
No

Approximately how long have you been actively working on your trauma healing? *

What areas of healing are most challenging? (select all that apply) *

What symptoms are you currently experiencing or have your experienced in the past 7 days? (select all that apply) *

Is there something specific you are seeking support to work through? Type 'No' if you are looking for general support and guidance *

Who else is part of your support system? (e.g.: professionals, coaches, energy workers, friends, family) *

I prefer sessions in the *

Mornings
Afternoons
Evenings

For scheduling purposes

I live in (US/Canada) *

For scheduling purposes

Please provide your location/time zone if outside the US/Canada

I understand that these meetings are in Central Standard Time *

I understand

I understand that Shanon is not a licensed professional counselor, she is a Certified Peer Support Specialist in the state of Wisconsin and a survivor with years committed to trauma healing. *

I understand

On the Journey Monthly Peer Support Program x4

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