Weekly in person support group pre-registration form
Empath in Berlin, Maria Zakrzewska, Clinical & health psychologist
Full Name
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First Name
Last Name
Pronouns
Age
*
E-mail
*
Phone Number
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Country code
Phone Number
Preferred form of contact. Please choose at least one
*
Phone number (text or call)
WhatsApp
Telegram
Email
Other
Which support group are you interested in. Please choose at least one
*
Parents of children with ADHD and on a spectrum
Adult ADHD, on the spectrum, neurodivergent
Parents, doctors, nurses and other carers
Couples
ENM or poly constellations
Other
When can you take part?
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Mornings
Afternoons
Evenings
Weekends
Other
How soon would you be interested in joining the support group?
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-
Day
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Month
Year
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What is your preferred sign up model
*
Single event
4-10 events as a bundle
Monthly subscription
Yearly subscription
Other
How likely are you to take part in a regular basis
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1
2
3
4
5
Not likely
Very likely
1 is Not likely , 5 is Very likely
Is there anything you’d like to add that wasn’t asked or specified here?
Submit
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