Groups Interest Form
We are accepting new members on a rolling basis for groups and add new groups as those groups fill. All groups are offered virtually and in person local to the Charlotte Area. Complete this registration form and our Groups Coordinator will contact you to enroll.
Participant Name
*
First Name
Last Name
Age / Grade (if applicable)
Parent Name (for minor clients)
First Name
Last Name
Email
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
Select Your Group
*
Friday Myths and Truths - 530pm - 7pm
Saturday Myths and Truths - 10am - 1130am
Other
Any Questions or comments on how we can help make this application process easier?
I understand I will be contacted upon registering to complete a required free 15-minute pre-screen phone call to ensure goodness of fit.
*
Yes
I understand that a non-refundable $25 deposit will be required after this call to hold my place in group or class. This purpose is to purchase supplies.
*
Yes
I understand the refund policy: Full refund less deposit with cancellation at least 14 day in advance. No refunds after group start. In very rare circumstances, the group may be deemed a inappropriate fit for the participant and/or maybe more support that can not be offered in the group is needed. In this instance, a prorated refund will be given for any groups not attended.
*
Yes
I understand that I am committing to attend the full series (4-8 sessions depending on group)and will make every effort to be present at each group meeting to support group cohesion & connection, and to get the most out of my group therapy experience.
*
Yes
I understand that prior to joining group I may discuss coordination of care with me and any other treating providers
*
Yes
Submit
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