Social Skills Group - Tiffany

Social Skills Group 2024

Group Therapy - July 10th - August 14th - Wednesdays
This group will provide fun and engaging Social Emotional Learning activities that promote healthy and positive peer interactions and friendships.

The age for this group is 7-9 years old.

Cost for each group session is $40 - Insurance accepted

Group will take place at our WWC Family Center

301 White Horse Pike

Haddon Heights, NJ 08035
Participant Name*

First NameLast Name
Parent or Guardian

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Birth*

MonthDayYear
Date
Reason for referring your child for this social skills group
Email*
example@example.com
Cell Phone*
Preferred Method of Contact*

E-mailCell PhoneText Message
This group is ongoing for 6 weeks. Dates to be determined. Please click the weeks you plan to attend:*

July 10thJuly 17thJuly 24thJuly 31stAug 7thAug 14th
Insurance Information
Most insurance plans will cover group therapy. Do you plan to use insurance for the group therapy fees?*

YesNo
If you are planning to use insurance, please provide the following information:
Insurance Carrier*
Member ID Number:*
Group Number:
If you are not planning to use insurance, please bring $40 to each group session. Checks made payable to Willow Wellness Center.
Should be Empty:

Social Skills Group 2024