DBT Skills Group
Please complete this form to receive pricing and sign-up details. Once five or more participants enroll, we’ll announce a start date. If you need services sooner, call our team at 617-675-6602 to schedule an intake.
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Who are you inquiring for?
*
Myself
My child or dependent
A patient of mine
Someone else
I am (or inquiring for) a:
*
Current patient of MH²
New patient of MH²
How did you hear about us?
*
Please Select
Internet Search
Social Media
Friend/Family
My Healthcare Provider
Podcast/YouTube
News/Television
Other
Preferred method of contact
*
Phone
Email
Additional message or questions:
Share anything to help us understand your needs.
Please verify that you are human
*
Submit
Should be Empty: