Discovery Call Questionnare

BMS Discovery Call

Thank you for your interest in our group sessions. At Black Mom Society, we offer empowering group sessions tailored for moms navigating life's transitions. Connect with a supportive community and gain valuable insights to help you thrive. Any information provided below are confidential and will not be shared with any other party.
Personal Information
Name*

First NameLast Name
Birth Date*

MonthDayYear
Email*
example@example.com
Cell Phone*

Area CodePhone Number
Preferred Method of Contact*
Schedule a 30min Discovery Call Appointment
Which Group(s) are you Interested In?

Individual SessionsGroup Session:Navigating New Chapters: Coaching for Moms in TransitionGroup Sessions: "Thrive and Shine: Mental Skills for Today’s Moms"Group Sessions: "Focused and Fearless: ADHD Management for Moms"Group Sessions: Parental Wellbeing: Fostering EmpowermentOther
Have you experienced any of the following?
What are your strengths?
What specific challenges or issues are you currently facing?
What are your areas of improvement ?
Authorization
By submitting this form, I authorize Blackmomsociety,LLC to contact me regarding the selected sessions. I understand that the purpose of this discovery call is to discuss my needs, goals, and how the sessions can support me. I consent to receive communications via phone, email, or text message for scheduling and conducting the discovery call. I acknowledge that this call is confidential and any information shared will be used solely for the purpose of providing tailored recommendations.
Date*

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Date
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BMS Discovery Call

Personal Information

Authorization