Clone of Expert Call

1

Client Name* This field is required.

First Name

Last Name

2

Email* This field is required.

example@example.com

3

Phone Number* This field is required.

Please enter a valid phone number.

4

Do you have a preferred contact method?* This field is required.

Phone Call Only

Email Only

Phone Call or Email

5

Is it okay to leave you a voicemail?* This field is required.

Yes

No

6

What is the client's date of birth?* This field is required.This is used to enter you in our electronic health system for your account.

7

Which group are you interested in?* This field is required.The Cypress, TX teen group has not started yet. The Woodbury, MN adult skills group begins 12/3; please do not attend any session until we contact you for an individual appointment and subscription review.

Teen Skills Class with DBT-A (for ages 13-18 in Cypress, TX)

Adult Skills Class with DBT (for ages 18+ in Woodbury, MN)

8

Please do not attend any group session until you have been contacted by our team.* This field is required.All interested participants will be scheduled for an individual appointment with the group facilitator and will receive details about the monthly subscription before joining.

By checking this box, you confirm that you understand these requirements.