To apply to join us in STRENGTH, fill out this form. Raffaela will then be in touch to let you know if your application has been accepted and what the next steps look like.

First Name *

Last Name *

Email *

Phone *

What inspired you to apply for STRENGTH today? *

In what ways does chronic skin picking (or your BFRB) impact your life? *

Over the next 12 months, what are the biggest changes you would love to see in yourself? *

On a scale of 1-10, how willing are you to take the action necessary to create the change you would love to see? *

1-3

4-7

8-10

*10 = highly willing 1=not willing

How ready do you feel to invest in the right program for you, both financially and time-wise? *

Ready now - just need a bit more info

Very interested - want to be sure it’s the right program

Interested - want to learn more before deciding

Just curious - not ready to invest right now

By submitting this form, I agree to the terms and conditions provided by Untapped Confidence.