Reclaiming Body Image in Menopause & Perimenopause Group Interest
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Are you currently seeing a psychotherapist (psychologist, social worker, counselor)?
Please Select
Yes
No
Do you prefer to attend group...
Please Select
in-person (Easton, MA)
via telehealth (anywhere in Massachusetts)
Group preference (day & time)
Please Select
Tuesdays at 7pm
Wednesdays at 7pm
What would you like to get from this group?
How did you hear about this group?
Group sessions meet for eight weeks. The $75 session payment is due each week at the time of session meetings. Credit cards will be stored on a secure app and charged the fee each week after meetings. Payment is due regardless of group absences. Please select below that you understand the timing and billing structure of this group.
I understand
Please feel free to add any questions here:
Submit
Should be Empty: