Request to join a group or workshop
Not sure which group is right for you? That's okay — just tell me a little about what's going on, and I'll help you find the best fit.
Name
*
First Name
Last Name
Email
*
example@example.com
Number
Format: (000) 000-0000.
Which group or workshop are you interested in?
*
Women's Perimenopause & Midlife Support Group
Fabulous Fifties & Beyond Support Group
Women's Life Transitions Support Group
Mindful Menopause Workshops
Preferred modality
Please Select
In-person
Virtual
What's bringing you here? (brief is fine)
You can share as little or as much as you like . . .
Have you worked with a therapist before?
Please Select
Yes, currently in therapy
Yes, in the past
No, this would be my first time
Prefer not to say
How did you hear about Mindful Moments?
Please Select
Therapist referral
Google search
Psychology Today
Instagram / Social Media
Friend / Family Recommendation
Other
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