Register for
Los Angeles – Be Mine Session (waitlist only)

Jan 28 - Feb 15, 2019

Los Angeles – Be Mine Session (waitlist only)


  • Jan 28 - Feb 15, 2019
  • 11840 S La Cienega Blvd, Hawthorne, California 90250, USA

Intake forms

Not sure what therapies you should be requesting for? Before filling out our registration form, you must first fill out the intake paperwork below. Once you do, our team of therapists will determine what type of therapies and how many hours are appropriate for an intensive session.

Apply for this session.

Patient Information

Patient Name*
Parent / Guardian Name*
Phone Number

Session Information

Session Duration*
Session Time Preference*
Type of Therapy*
Would you like a break in the session?*
Break Length*

Session Preferences

Which preference is most important to you?*
Which start times will work for you?*

We do our best to match your child with therapists they've worked with in the past but this is not guaranteed. If you're flexible or unsure on your child's therapy team, leave the section below blank and we will do our best to match your child with who we think they will work with best.

Therapist 1
Therapist 2
Therapist 3
Therapist 4
Would you like to stay at the NAPA apartment?*
Patient Intake Paperwork Completed?*
Additional Requests