Intercept Pattern Tracking Form

Intercept Pattern Tracking Form

The purpose of this form is to help you identify and track behavior patterns so that you can make corrections quickly and celebrate victories regularly.

Intercept members are required to submit this form weekly.

Password*

Date of Meeting*

User ID*

Type in part of your User ID to narrow the search

Select

Weekly Scores

PBJ's

MAP's

5 - No Temptation

4 - Tempted but Chose Purity

3 - Non-Adjustment Self Touching

2 - Starting and Stopping

1 - Gratification

0 - Multiple Occurrences of a 1

5 - No Temptation

4 - Tempted but Chose Purity

3 - Double Takes / 2nd Glances / Scanning Body Parts

2 - Undressing with Mind / Sexualizing / Fantasizing

1 - Seeking Physical or Emotional Connection

0 - Multiple Occurrences of a 1

5 - No Temptation

4 - Tempted but Chose Purity

3 - Seeking Nudity or Titillation and Quickly Stopping

2 - Willfully Engaging in and Stopping

1 - Willfully Engaging in and Not Stopping

0 - Multiple Occurrences of a 1

Attendance*

Yes

Reason for Absence*

Friendly reminder that you committed to call (not text) your group leader prior to group to discuss any absences. If you have not done that yet, be sure to make the phone call now.

Homework*

Complete

Incomplete

STC Creation or Progress*

Yes

Are you current with Intercept Membership Dues?*

Yes

To get current on dues, use the Intercept App or go to Intercept.works/pay. If you require financial assistance, submit a Scholarship Request.

Did you actively use any of the Intercept tools you've learned?*

Yes

Form Instructions

Once you type in the full and correct password, the form questions will magically appear below. After completing all questions, click "Submit."

If needed, contact your leader to confirm the correct form password.

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