Enroll Form | Innsightful

Please set aside 7-10 minutes to complete the registration.

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You must use your university email to sign up to our program. You will need this account to register and view the program resources.

University Email *

Password *

I hereby confirm that I have read, consent, and agree to Innsightful’s Terms & Conditions and Privacy Policy.

What is your first name? *

What is your last name? *

What’s your phone number? *

What is your age? *

Are you Hispanic or Latino? *YesNo

Are you attending a two- or four-year college/university? *YesNo

We're sorry! This program is only for college of university students. We will let you know when programs for non-university students become available.

Nice to meet you!

Innsightful is a 12-week program, where we take you on a meaningful journey that will improve your wellbeing. We want to create a safe and non-judgmental environment for everyone.

Are you willing to keep all conversations within our program private and confidential? *YesNo

To continue to use our service, you must be willing to keep all conversations within our program private and confidential.

You will be part of a small group that you will meet weekly for 1 hour. We expect that you will chat and support group members, you will express your feelings when you’re ready, and involve in activities that we have prepared to help you.

Attendance in the first four sessions in mandatory, but you may miss meetings in emergency cases. *I'm likely to make all meetingsI might miss 1-2 meetingsI might miss 3+ meetings

To receive the most effective help, you should be able to attend all or most meetings.

Do you have a coupon *

Coupon *

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Your coupon is valid. You can continue to the next part of registration.

Credit / Debit Card *

Total Amount: $320

Thank you for registering! We need more information from you to get you started in a group. Let’s go!

What is the name of your university? *

Are you part of the Transformational Leaders program? *YesNo

Are you an international student? *YesNo

What kind of groups do you prefer? *Mixed gender groupsSingle gender groups

What is your preferred meeting time? *

Now we want to understand your current wellbeing to help you get better. In order to best help you, we need to understand you individually…

Over the last 2 weeks, how often have you been bothered by any of the following problems?

Little interest or pleasure in doing things? *Not at allSeveral daysMore than half the daysNearly every day

Feeling down, depressed, or hopeless? *Not at allSeveral daysMore than half the daysNearly every day

Trouble falling or staying asleep, or sleeping too much? *Not at allSeveral daysMore than half the daysNearly every day

Feeling tired or having little energy? *Not at allSeveral daysMore than half the daysNearly every day

Poor appetite or overeating? *Not at allSeveral daysMore than half the daysNearly every day

Feeling bad about yourself or that you are a failure or have let yourself or your family down? *Not at allSeveral daysMore than half the daysNearly every day

Trouble concentrating on things, such as reading the newspaper or watching television? *Not at allSeveral daysMore than half the daysNearly every day

Moving or speaking so slowly that other people could have noticed. Or the opposite being so figety or restless that you have been moving around a lot more than usual? *Not at allSeveral daysMore than half the daysNearly every day

We’re almost there… Help us personalize our program for you and get you the best help.

Over the last 2 weeks, how often have you been bothered by any of the following problems?

Feeling nervous, anxious or on edge? *Not at allSeveral daysMore than half the daysNearly every day

Not being able to stop or control worrying? *Not at allSeveral daysMore than half the daysNearly every day

Worrying too much about different things? *Not at allSeveral daysMore than half the daysNearly every day

Trouble relaxing? *Not at allSeveral daysMore than half the daysNearly every day

Being so restless that it is hard to sit still? *Not at allSeveral daysMore than half the daysNearly every day

Becoming easily annoyed or irritable? *Not at allSeveral daysMore than half the daysNearly every day

Feeling afraid as if something awful might happen? *Not at allSeveral daysMore than half the daysNearly every day

We feel like we know you much more now! Just a few more questions and we’re done!

In the last month, how often have you been bothered by any of the following problems?

Last questions, we promise!

What are your expectations from this program? Please be as specific as possible. *

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Innsightful Emotional Wellness Program