ReCODE Support Group Registration

Thank you for your interest in this group, facilitated by ReCODE 2.0 Certified Coach, Linda Meeks.

Sessions are held on the Zoom platform; all details for attendance will be sent to you by the facilitator after completed registration; please allow a few days for processing.

This group meets on the second Thursday of the month at noon to 1:30pm PT; 3:00pm to 4:30pm ET, on an ongoing basis; your first session is the 2nd Thursday of the month after your registration.

Cost: The cost is $150 for a 6-month period, with a single 90-minute session per month, and the ability to register for additional 6-month periods for continued support.

If you have any questions, please email coaching@ahnphealth.com.

Please have your form of payment handy before beginning registration, so that it can be completed. If you leave this form without payment, you will not be registered in our system, and you will not be able to return to complete registration. We apologize for any inconvenience.

Refunds for our programs will be issued by a written request received within 48 hours of the end of the first session. All requests must be sent to apollohealthcoaching@ahnphealth.com. No refunds will be processed after 48 hours.

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* 1. First Name

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* 2. Last Name

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* 3. Address

Address

City/Town

State/Province

ZIP/Postal Code

Country

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* 4. Email Address

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* 5. Phone Number

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* 6. Are you a member of ReCODE?

Yes

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* 7. If no, is your loved one a member of ReCODE?

Yes

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* 8. If your loved one is a member, what is their name?

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* 9. Are you currently working with a ReCODE practitioner?

Yes

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* 10. Please share how you hope this group will be helpful to you (and/or your loved one):

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* 11. Unless there’s an emergency, I commit to attending all 6 sessions of the support group

Yes

ReCODE Support Group Registration

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* 1. First Name

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* 2. Last Name

Question Title

* 3. Address

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* 4. Email Address

Question Title

* 5. Phone Number

Question Title

* 6. Are you a member of ReCODE?

Question Title

* 7. If no, is your loved one a member of ReCODE?

Question Title

* 8. If your loved one is a member, what is their name?

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* 9. Are you currently working with a ReCODE practitioner?

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* 10. Please share how you hope this group will be helpful to you (and/or your loved one):

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* 11. Unless there’s an emergency, I commit to attending all 6 sessions of the support group

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* 12. Anything else you'd like to mention: