Healthy Connections Group: Thursdays at 6:00pm

Group Therapy Form

Healthy Connections Group: Thursdays at 6:00pm
Please Note: Filling out this form does not automatically enroll you in our Healthy Connections Group. Once you complete the below form, the group facilitator will reach out to conduct a pre-screen assessment to confirm goodness of fit.
Name*

First NameLast Name
Email*
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Phone Number*
Please enter a valid phone number.
Are you based in the state of Illinois?

YesNo
What is you inquiry?*
Is there anything you would like us to know? (Optional)
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Group Therapy Form