Customized Agency Training Pre-Consultation Form · Solution-Focused Therapy Institute

Agency Name*

Contact Name*

First Last

Can the contact make decision for the Agency?*

Yes
No

Email*

Phone

Agency Website

Agency Address

City State / Province / Region ZIP / Postal Code Country

Population served

Licensure level of participants

Projected number of participants for training

Preferred dates/time frame for training

Preferred duration and length of training

Has your agency received any Solution-Focused training in the past?*

Yes
No

If yes, please enter the prior training below:

What are your best hopes for your training so you can say it was worth your time and money?

What would indicate to you that the training has been successful and we have met your needs?

Is there anything you think would be important for us to know in order to help us create the most successful customized training specific to your agency?

Please provide your preferred days and time you can be available for a Zoom Consultation with Anne B. Lutz, MD.*

How did you hear about us?*