Purity Culture Group Application

Healing from Purity Culture Therapy Group

Interested in joining the group? Please fill out the application and I will be in touch shortly! I can't wait to hear from you.

Name

First Name

Last Name

Phone

(###)

###

####

What is your religious background?

What are some challenges related to purity culture you are currently facing?

Have you participated in therapy or support groups before?

Check all that may apply

Individual therapy

Group therapy

Support groups

This is my first one

What are some things you're hoping to work on or talk about in this group?

Do you have a support system outside of this therapy group?

Yes!

Not really

I'd like to be connected to some resources.

Is there anything else you would like Victoria to know?

Victoria R. Leon, ASW #113665

Victoria is an associate clinical social worker offering therapy at Monarch Rising Therapy under the supervision of Stacie Fanelli, LCSW #105876

Monarch Rising Therapy is not an appropriate source for emergency services. For crisis support that does not involve the police, please visit the resource page. 

Due to licensing laws, I can only conduct therapy sessions with clients located in the state of California.

Monarch Rising Therapy is located on  Tongva (Gabrieleno) and Acjachemen (Juaneño) land. To learn more about Tongva and Acjachemen and other territories you are occupying, click here.