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About
Our Process
Our President
FAQ
Donate
Experiences
Heart Program
Soul Program
Virtual Cohorts
Weekend Intensives
Apply Today
Resources
Online HEART Course
Our E-Book
Holy40
Book Recommendations
Counseling Services
Blog
Donate
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PLUMLINE APPLICATION
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Plumline Application
First Name
*
Last Name
*
Email
*
Phone
*
I'm Interested In...
*
-- Please Select One --
1:1 Coaching
12-week Cohort
Marriage Weekend Intensive (for couples)
Weekend Intensive (for individuals)
How did you hear about Plumline?
*
What are you hoping to get out of this Plumline experience?
*
Have you done counseling or therapy previously?
*
-- Please Select One --
Yes
No
Prefer not to answer
Have you considered or attempted harming yourself in the past 12 months?
*
-- Please Select One --
Yes
No
Prefer not to answer
Do you have any questions or concerns about group work?
Consent
*
I Agree
By providing personal information to us, you consent to us collecting, holding, and using your personal information in accordance with the
Plumline Privacy Policy
.
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Name
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