This screening is designed to help determine if a participant is ready for a Genesis Change Groups experience. Genesis Change Groups focus on healing underlying wounds, building safe relationships, identifying relapse patterns, and developing long-term recovery and life-change tools.
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Question 1 of 5
Contact Information: Please include full name, phone number and email address.
Question 2 of 5
Select the main problem you'd like to change or work on in our group.
Addiction(s): Drugs, alcohol, pornography, gambling.
Anger
Anxiety
Depression
Fears
Question 3 of 5
Strongly disagree
Disagree
Unsure
Agree
Strongly Agree
Question 4 of 5
On a scale of 1-5: How willing are you to give and receive support from others?
Strongly Disagree
Question 5 of 5
How do you think Change Group will help you?