Interest in Groups (Self-Referral)
Please complete this form if you are interested in the community wellness groups at Mental Refuge Therapy Services. Our team will be in touch with you shortly. This form is private and confidential. If you have questions about this form, please email admin@mentalrefuge.ca
About You
Full Name
*
First Name
Last Name
Preferred contact information (phone number and/or email address)
Group(s) of Interest
Please let us know which group(s) you are interested in attending. You may select as many as you like. Please visit the website for group description.
Self-Care for the Self-Sustaining
LGBTQ+ and racialized
Loving our Children while Loving Ourselves
While in Waiting
Schedule
Please let us know your general schedule, so that we can account for your availability when determining the dates/times for the group. You can be specific (eg. "Mondays, Wednesdays and Fridays at 5 and 6 pm") or general (eg. "weekends"). If you are unsure about your schedule, please indicate so.
Location
Do you have a preference for in-person versus virtual gatherings?
I prefer in-person
I prefer virtual
I like both in-person and virtual gatherings
If you are available for in-person gatherings, please tell us what area of the Greater Toronto Area (GTA) you live in. If you do not live in the GTA, please indicate.
If you are available for in-person gatherings, please share your primary mode of transport
public transit (bus, subway etc)
car/personal vehicle
taxi/Uber
Other
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