Social Skills Group Form

Social Skills Group Form
Thank you for your interest in our group! Please complete the form below and one of our therapists will give you a call with next steps. If you have any questions in the interim, please feel free to call (516-785-0323) or email (info@sscpsli.com) our office.
Child's Information

Please note the group is open to children between 7-9 years old.
Child's Name

First NameLast Name
Child's Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Child's Grade Level
Insurance Information, with policy number
Parent/Guardian's Information
Parent/Guardian's Name

First NameLast Name
Parent/Guardian's Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian's Email
example@example.com
Questions
Is your child currently seeking individual therapy at South Shore Counseling and Psychological Services, or have they in the past? If so, please type their therapist's name below.
The group will run on Mondays from 5:15-6:15 PM at our Wantagh office. Is your child able to commit to these meetings?
Why do you feel your child would benefit from a social skills group, and what are you hoping your child will learn or take away from this group?
What do you see as your child’s greatest strengths or skills, and where would you like to see them improve?
How would you describe your child’s personality? Are there any behavior struggles we should be aware of?
Is there any other information you would like for us to know about your child?
Should be Empty:

Social Skills Group Form

Child's Information

Parent/Guardian's Information

Questions