Norm Therapy® Interviewee Form

NORM THERAPY®
INTERVIEWEE FORM

Norm Therapy® takes the victim through an elaborate process of identifying their abusive circumstance(s), their strengths, their weaknesses and provides cursory solutions towards preparing the victims for a more formalized professional counselling, therapies and possible extraction from their abuse. Further, this process requires a “Last ditch effort response” on behalf of the victim. “It’s impossible to help someone who isn’t helping themselves”. This service costs ARO thousands of dollars for each group to successfully complete our Norm Therapy® program. Access to traditional abuse care treatment is limited and cost prohibited. Only a small segment of our global society are able to enjoy the services of psychologists, clinicians, therapists, psychiatrists, doctors and the like. For these reasons, ARO is currently raising monies and awareness, on the highest levels, to develop a cost free access portal to all of your abuse care related therapeutic needs. Norm Therapy® helps you to recall the origins of how events actually occur in life so you don’t have to defend the things that don’t. The only way to your truth is to trust us at ARO. We have nothing to gain but your wellness.

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Norm Therapy Interviewee

WARNING: Please read carefully and fill it out completely. Any false information will result in your application being immediately withdrawn and your being permanently banned from ARO and our Victim/Survivor Interview Program! It is imperative that you fully understand that throughout the entirety of Norm Therapy®, complete honesty is paramount towards success. If you are unwilling to be honest through the entire program, you should probably not sign up for Norm Therapy™.*

I've read, will comply and understand

Are you in danger now? - If you are concerned for your safety, please contact the appropriate authorities for your jurisdiction, whether that be 9-1-1 or otherwise. ARO, Norm Therapy®, nor any of its affiliates are responsible for your safety. Please seek appropriate help, if needed, prior to soliciting our support.*

YES

LIKELY

UNSURE

First Name*

First Name

Last Name*

Last Name

Email*

Mobile Phone*

Provide Mobile Phone

City/Town/Village*

City/Town/Village

State/Province*

State/Province

Zip/Postal/Mail Codes*

Zip/Postal/Mail Codes

Country*

Country

Please Upload current ID (Passport, Driver's License or other Government Issued ID)

File Upload*

Upload

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File Upload - PDF, JPG, JPEG & PNG Only

Please comprehensively explain why you chose Norm Therapy®?*

Please comprehensively explain why you chose Norm Therapy®?

Further select from the list all of the abuse experiences you've had, personally and/or professionally.*

Narcissistic Abuse

Child Abuse

Domestic Violence

Financial Abuse

Psychological Abuse

Bullying

Cyberbullying

Self Abuse

Sexual Abuse

Physical Abuse

Spousal Abuse

Other

Briefly but accurately describe your abuse experience(s).*

Please comprehensively explain why you chose Norm Therapy™?

Are you or have you ever been a volunteer with Abuse Refuge Org (ARO)?*

Yes

If "YES", please explain what you are currently involved with ARO or previously involved. Please name your Manager, Supervisor, Dates involved and any other additional information.

Please comprehensively explain why you chose Norm Therapy®?

When are you looking to start Norm Therapy® and conduct your initial interview?*

Immediately - Next Available Interview

Within 2 Weeks

Within 2-3 Months

Within 6-12 Months

Therapy Availability Date*

Availability Date

Signature

Norm Therapy® Interviewee Form

Norm Therapy® Disclaimer

Norm Therapy® does not provide mental health treatment and does not constitute a client/therapist relationship, which will only be established and assigned after a complete initial consult at ARO, completion of the Norm Therapy® and a signed consent upon completion of the aforementioned. We are not licensed Clinical Social Workers. We do not provide diagnosis via our website nor anywhere else within the ARO or Norm Therapy® Communities. The information provided on our site is not a replacement for a therapeutic relationship in psychotherapy or the coaching relationship. The information we provide, in any forum, website or interview, does not replace medical advice. We are not a Medical Provider (Physician, Psychiatrist, Nurse Practitioner, etc.). You agree and acknowledge that we are not providing health care, medical or nutritional therapy services, or attempting to diagnose, treat, prevent or cure any physical, mental or emotional issue, disease or condition. The information provide in or through ARO’s interviews or website pertaining to your health or wellness, exercise, relationships, business/career choices, finances, or any other aspect of your life’s not intended to be a substitute for the professional medical advice, diagnosis or treatment provided by your own Medical Provider or Mental Health Provider. You agree and acknowledge that ARO, any of its staff, nor Norm Therapy® are not providing medical advice, mental health advice, or religious advice in any way whatsoever.

NOTE: Always seek the advice of your own Medical Provider and/or Mental Health Provider regarding any questions or concerns you have about your specific health or any medications, herbs or supplements you are currently taking and before implementing any recommendations or suggestions from our website or through interviews and discussions. Do not disregard medical advice or delay seeking medical advice because of information you have read on our website or heard from any of our staff. Do not start or stop taking any medications without speaking to your own Medical Provider or Mental Health Provider. If you have or suspect that you have a medical or mental health problem, contact your own Medical Provider or Mental Health Provider promptly. The information contained on our website has never been evaluated by the Food and Drug Administration.

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Michael

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