Work With Dr. Laurie Bruce

Membership Application | Mindful Membership for Therapists

Dr. Laurie Bruce

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Name

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Email Address

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Time Zone

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Please share with me what prompted you to sign up for this membership, including any difficulties or challenges you are experiencing in your life right now.

Please share what prompted you to apply.

What goals would you like to work on or what do you hope to accomplish by the end of this 12-month membership?

Please share your goals for this program.

How motivated are you to make changes in your life right now?

Not motivated at all. Someone or something else is pushing me to do this. Minimally motivated. I'm willing to see if it helps or if my motivation improves. My motivation varies from minimally to very motivated. I'm inconsistent. Very motivated. I know I just need extra support and accountability. Extremely motivated, ready to do what it takes!

Please select your motivation level.

What is your occupation?

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What is/are your biggest challenges in your professional life at this time?

Please share your professional challenges.

Important Acknowledgment

By applying for membership, you are acknowledging that you understand and agree that both of these programs are group coaching experiences. Membership is not therapy, clinical supervision, or providing medical treatment. It is meant to be a supplement or adjunct to personal therapy and/or supervision but it is not a replacement.

I understand and agree to the above statement.

You must acknowledge this statement to continue.

Membership Application

Additional Questions for Practitioners

Important Acknowledgment