Therapy Group Interest Form

Therapy Group Interest Form

To sign up for one of our therapy groups, please complete the form below and we will contact you when we have an opening
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Please select the group you are interested in attending:*

Parent Support Group (Saturdays at 1pm, Starting June 10, for 8 weeks)Future Parent Support GroupFuture Child Support GroupFuture Adolescent Support Group
Please briefly describe why you are interested in attending one of our therapy groups
Please acknowledge the following: 8 week groups cost $480 total ($60 x 8 weeks). Each meeting lasts 1.5 hours and in-person attendance is preferred. Payments for groups are due in two payments, half of the balance is due before the first group meeting, with the remainer due after the fourth meeting. Couples/family discounts are available, and any caregiver in addition to the primary caregiver who wishes to attend can do so for a discounted rate of $30 per session attended. This is a CLOSED group, meaning once the group starts, new members will not be added and must wait until a new group begins. Submitting this form does not guarentee admittance to the therapy group. A therapist will call you for a free consultation to determine whether the group is a good fit for you or your family.
Please acknowledge that you have read and understand the above information.*

I agree
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