Grace to Thrive Therapeutic Group
Participant's Name
*
First Name
Last Name
Participant's Email
*
example@example.com
Participant's Phone Number
*
Please enter a valid phone number.
What do you hope to gain by participating in this group? What concerns do you have about being a member of this group? Do you have any questions?
*
The expectation is that group members will attend each group, participate in group discussions and activities, and complete follow-up homework assignments. Do you believe that you can commit to this level of participation? Are there any situations or circumstances that may impede your full participation?
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This will be a therapeutic group but is not meant to take the place of clinical counseling services. All group members must attest to being in a well enough state to engage in therapeutic activities without the present need for clinical services. Do you understand the above stated and can attest to being in a well enough state to engage in this therapeutic group without the present need for clinical services?
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Yes
No. I need referrals for clinical counseling services instead.
I understand that the fee for the group is non-refundable and non-transferable. If I choose the installment plan for payment, I understand that the 2nd installment will be withdrawn automatically within 1 month and the final payment is due no later than April 25, 2023. If my 2nd installment is not received by this date, then my deposit will be forfeited and my spot will be relinquished to another participant.
*
Yes, I understand.
Products
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Grace to Thrive Therapeutic Group
One-Time Payment
$
240.00
one-time payment
Grace to Thrive Therapeutic Group Installment Plan
2 Monthly Payments
$
130.00
for each
month
Credit Card
Submit
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