Retreat Intake Form

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Where I am Today

(1 = not at all/10 = extremely)

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Understanding & Agreements

I/we understand that I am responsible for the choices I make and the consequences that follow and that The Coffman Company is not held liable for those choices.
I/we understand that everything I/we say is confidential unless I/we are considered to be a physical threat to myself or another or unless unreported abuse has occurred (as required to report by law).
I/we understand the fee charged for the retreat and will cooperate with our agreement.
I/we understand that Joey Coffman has an MDiv in Pastoral Counseling and Robyn Coffman has a Masters in Marriage and Family Therapy. They are certified under the BCPPC (Board of Christian Professional and Pastoral Counselors), and are not licensed by the state of Arizona.

Thank you!

Background