Application for Intensive
Thank you for your interest in our intensive programs. We believe that intensive counseling experiences can be incredibly powerful and effective in laying a solid foundation for the work of recovery and healing. However, intensive are not the right fit for all people.

We are committed to giving our intensive clients the experience that is right for THEM. That means that we do not use formulaic, rigid approaches. Instead, we design each and every intensive experience specifically for the needs of that client after a thorough intake and assessment process.

To provide you the best experience possible, we carefully screen all who are interested in undergoing intensive counseling. Completing this form is the first step in collaborating in the intensive creation process.

Once you complete the form, you will be able to schedule your 20 minute consultation call immediately; the link will be provided on the confirmation page. If you prefer to book the consultation over the phone, please call 855-602-2554 after you submit your application. PLEASE NOTE: This application is only for a couple's intensive experience. For any other type of intensive inquiry, please call our office or you can send an email to frontdesk@daringventures.com

The answers provided on this form are confidential, and your honesty in responding give the best hope of getting the help you need. We look forward to the possibility of working with you!

Due to the volume of applications we are receiving, and to ensure we are able to offer the highest quality of service possible, you will be asked to pay a $20.00 non-refundable administrative fee when you book the consultation call.
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First and Last Name *
Email *
Phone Number *
If you are in a relationship, what is your partner's first and last name? *
What is your partner's email address? (This is required for us to get you into the system. We will NOT contact your partner without permission.) 
*Please note, your email addresses must be different.
 *
What is your partner's phone number? (This is required for us to get you into the system. We will NOT contact your partner without permission.) *
Where do you live? *
Are you or your partner currently a client of Daring Ventures? *
If yes, who are you working with?
You are (select all that apply): *
Required
How old are you? *
If you are in a relationship, how old is your partner? *
Please list all children and their ages. *
What is your current living situation? *
What is your occupation? *
What is your partner's occupation? *
If you are currently in a relationship, is your partner also interested in an intensive experience? *
What type of intensive are you seeking? *

Have you undergone a formal therapeutic full disclosure, facilitated by a professional experienced in the disclosure process?
 *
If yes, did your disclosure include the use of a therapeutic polygraph? *
Are you currently under the care of another helping professional (therapist, coach, counselor)? If so, who? Please include name, email, and phone number. *
Is your partner currently under the care of another helping professional (therapist, coach, counselor)? If so, who? Please include name, email, and phone number. *
Please provide a summary of what brings you to the point of applying for an intensive. Give enough background and detail to give a clear picture of your current situation and needs. *
Where did you grow up? Describe the atmosphere of the home in which you grew up. (If you are in a relationship, please answer this about your partner's background, as well.) *
How many times have you or your partner been the plaintiff or defendant in a lawsuit? *
Are you currently experiencing any suicidal or homicidal thoughts? *
Have you or your partner currently filled for divorce? *
Is there anything else you believe we need to know?
Are you who you say you are? (Sorry, we have to ask!) *
Required
By clicking the box below, you agree to the following: "I understand this application does not ensure that I will be able to have an intensive, but it begins the process of applying for an intensive. I understand that prior to receiving a formal proposal for an intensive experience, I may be required to complete online assessments and undergo intake sessions. I further understand that if it is learned that anything in this application is a misrepresentation of the truth, my intensive could be cancelled with no refund of fees paid up to that point in the development of my custom intensive experience." *
How did you first hear about Daring Ventures or Dr. Jake?  *
If your initial introduction to Daring Ventures or Dr. Jake was through a podcast, could you please specify which podcast it was?
If your initial introduction to Daring Ventures or Dr. Jake was through social media, could you please specify which platform?
Who should we thank if someone referred you to us? *
Are you ready to book your consultation call and pay the $20 application fee? *
Next Steps: Booking Consultation
Thank you for taking the time to complete this application. After you submit, you will be able to click our scheduling link to book your 20-minute consultation call with our intensive coordinator. *Please note both individuals are required to be present for the consultation call for the Couples Intensives.* If you prefer to book your consultation over the phone, please email frontdesk@daringventures.com and someone from our team will contact you.
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