Virtual Group Registration Form (Depression: Breaking the Cycles)
These virtual group sessions are dedicated to providing a safe space to help you in understanding and overcoming the challenges of depression. Join us for insightful discussions, practical tips, and interactive sessions that will assist in successfully navigating through the struggles. Together we will break the stigmas, gain support on the journey to better mental health. Don't miss out on this opportunity to learn and grow because your mental health matters! Register now and take the first step towards breaking the cycle of depression!
Participant Information
Name
*
First Name
Last Name
Phone Number
*
Email
*
example@example.com
Payment Information
Group Session Schedule
April 9
7:00 PM - 8:30PM EST
April 16
7:00 PM - 8:30PM EST
April 23
7:00 PM - 8:30PM EST
April 30
7:00 PM - 8:30PM EST
Payment (Select one or more-registration fees are non-refundable)
*
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Participation Fee - April 9
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$
40.00
Participation Fee - April 16
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$
40.00
Participation Fee - April 23
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$
40.00
Participation Fee - April 30
Enter credit card information below
$
40.00
*Participation Fee- Georgia Medicaid (Amerigroup, Caresource, Peach State only)
Submit picture of insurance card below
$
Free
Payment Methods
Credit Card
Apple Pay
After submitting the form, you will be redirected to Apple Pay to complete the payment.
Take Photo
*Select participation week (s) if participating through insurance.
April 9
April 16
April 23
April 30
How did you learn about this virtual group?
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