BBTRS Group Facilitator Training

Your Application Data

We understand the potential sensitivity facing some of the questions below. This can be a very vulnerable area in your life. This information is valuable to us for knowing and understanding you better which enables us to make an educated determination about your attendance in the program. We strive to offer the most appropriate and best possible care & support for you. Please answer honestly. These questions and answers are strictly confidential and will be reviewed by the Training facilitation & coordination team only.

Please confirm that your information is accurate on the second page of the form before you submit your application. Thank you so much!

Personal Information:

Full Name *

Email *

Phone *

Date of birth *

Country of Residence *

Gender *

Medical Questions

Are you currently seeing a counselor, psychiatrist, or psychologist? *

Yes

Are you now being treated or have you ever been treated for any mental health conditions, including, for example (but not limited to) PTSD, psychosis (including drug-induced psychosis), chronic anxiety, bi-polar disorder, and sleeping disorders that required taking any form of medication and/or hospitalization? *

Yes

Have you ever been a patient in a mental health care facility? *

Yes

Are you currently taking or have been prescribed psychiatric medications? If yes, please share which prescriptions, for what diagnosis, for how long and the results? *

Yes

Have you ever been diagnosed with any type of personality disorder?* *

Yes

Are you currently under the care of a medical doctor? *

Yes

Are you currently taking any medications? *

Yes

Do you currently have any communicable diseases? *

Yes

Experience

What previous "personal development trainings/workshops" have you attended? *

Why BBTRS®? *

Final Questions and Comment

How did you find us? *

What do you hope to take away from attending this event? *

Add a message if you wish.

Please take a moment to read through our Terms and Confidentiality Agreement & Privacy Policy and indicate your acceptance by marking the check box below.

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