Breakthru: A Place for Personal Development and Relationship Enhancement


In helping determine what method of communication you want to employ with us, we need to remind you if you choose to communicate with us via electronic transmission (video conferencing, faxes, cell phone, and/or emails), that, in this day and age of hackers, there is no 100% guarantee of confidentiality for any of us via electronic transmission. However, we’ll do our utmost to preserve your communication’s confidentiality through our security procedures.

Step 1. For New or Returning Former Client’s Appointment Setup:

Click here to fill out the Prospective Client Data Form Online (Or download and complete the Prospective Client Data form, then fax or mail to BCC).

Step 2. For Clients Who Have a Booked Appointment:

Please complete the forms below. Click on each form below that applies to you to complete it online (or download the forms, complete and Mail or fax into BCC).

Online Forms Option to Fill Out and Submit Online

*For Best Results, please use “Google Chrome” Browser

*Please only use your “tab” key to move through the form(s)

Adult (21 years+) Client Forms


Download Version of Forms To Print Out

Adult (21 years+) Client Forms