The 4th Trimester Circle
Our postpartum therapy group offers a caring, judgment-free space for parents adjusting to the challenges of postpartum life. Together, participants will explore ways to understand their thoughts and emotions, reduce anxiety and overwhelm, and practice simple coping tools that feel realistic in daily life. Through guided discussion, mindfulness, and supportive connection, this group is designed to help parents feel more grounded, more supported, and more confident in their healing journey. Please complete the form to request enrollment and participate in the screening. Have your information ready. We will contact you within 48 hours of your registration.
Initial Enrollment Information
Full name
*
First Name
Middle Name
Last Name
Preferred name
Date of birth
*
-
Month
-
Day
Year
Date
Pronouns
Email address
*
example@example.com
Phone number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Preferred contact method
*
Email
Phone
Text
City and state
*
Emergency contact name
*
Emergency contact phone number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Relationship to emergency contact
*
Are you currently pregnant, postpartum, or trying to conceive?
*
Pregnant
Postpartum
Trying to conceive
Prefer not to say
Other
If pregnant, what is your due date?
-
Month
-
Day
Year
Date
If postpartum, how many weeks/months postpartum are you?
Referring provider or therapist name, if any
Are you currently seeing an individual therapist?
*
Yes
No
Are you currently taking psychiatric medication?
*
Yes
No
Prefer not to say
Insurance provider or payment method
What are you hoping to get from the therapy group?
*
Have you participated in group therapy before?
*
Yes
No
Anything else you would like us to know?
EPDS-US Screening
Please select the response that comes closest to how you have felt in the past 7 days, not just how you feel today.
I have been able to laugh and see the funny side of things.
*
As much as I always could
Not quite so much now
Definitely not so much now
Not at all
I have looked forward with enjoyment to things.
*
As much as I ever did
Rather less than I used to
Definitely less than I used to
Hardly at all
I have blamed myself unnecessarily when things went wrong.
*
Yes, most of the time
Yes, some of the time
Not very often
No, never
I have been anxious or worried for no good reason.
*
No, not at all
Hardly ever
Yes, sometimes
Yes, very often
I have felt scared or panicky for no very good reason.
*
Yes, quite a lot
Yes, sometimes
No, not much
No, not at all
Things have been getting on top of me.
*
Yes, most of the time I haven’t been able to cope at all
Yes, sometimes I haven’t been coping as well as usual
No, most of the time I have coped quite well
No, I have been coping as well as ever
I have been so unhappy that I have had difficulty sleeping.
*
Yes, most of the time
Yes, sometimes
Not very often
No, not at all
I have felt sad or miserable.
*
Yes, most of the time
Yes, quite often
Not very often
No, not at all
I have been so unhappy that I have been crying.
*
Yes, most of the time
Yes, quite often
Only occasionally
No, never
The thought of harming myself has occurred to me.
*
Yes, quite often
Sometimes
Hardly ever
Never
I understand that this screening form is not a diagnosis and is reviewed as part of the enrollment process.
*
I understand
If you selected anything other than Never for thoughts of self-harm, please contact 988, call 911, or go to the nearest emergency room if you are in immediate danger.
Consent
Certification of Accuracy
*
I certify that the information I provided is accurate to the best of my knowledge.
Consent to Contact
*
I consent to be contacted about therapy group enrollment.
Submit
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