Embracing Awkward: A Social Skills Group

Embracing Awkward: A Social Skills Group

If you are interested in joining this group, please fill out this intake form.
Name

First NameLast Name
Pronouns
Email
example@example.com
Phone Number
Please enter a valid phone number.
Are you a current client of Clintonville Counseling and Wellness?

YesNo
What is your preferred method of contact?

Simple Practice Portal (current CCW clients)EmailPhone
Have you ever participated in a group before?

YesNo
If yes, please select all that apply:

CounselingSupportSocialOther
Do you have any concerns about participating in a group setting?

YesNo
If yes, please explain.
What do you hope to gain from this group?
What would you consider to be your strengths when interacting with others?
What would you consider to be areas for growth when interacting with others?
Can you commit to attending 4, 2 hour sessions?

YesNo
Do you have any questions or concerns?

YesNo
If yes, please state them below.
If you are currently in therapy, who is your current therapist/counselor?
The group's facilitator, Jess Homan, LISW-S, will contact you briefly before the group starts to make sure it will be a good fit. This is a closed group that will meet in person. It is recurring, so if the start date doesn’t work for you - keep an eye out for when the next one begins!
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