• ToGather Circle Parent Interest Form

    Thank you for your interest in ToGather Circle! This screening form helps us learn a little about your daughter to determine whether this group may be a good fit. Completing this form does not enroll your child in the group. After reviewing your responses, we'll contact you to discuss next steps and, if appropriate, schedule a clinical assessment.

  • Parent/Guardian Information

  • Format: (000) 000-0000.
  • Preferred Method of Contact*

  • Participant Information

  • Date of Birth*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Is the Participant a current client at Aspen Ridge?*

  • Tell Us About Your Daughter

  • What challenges has your daughter been experiencing? (Please check any that apply)*
  • During the past few months, how often has your daughter experienced...*
    Rows

  • Tell Us About Her Strengths

  • About Group Participation

  • Previous Support

  • Has your daughter previously received any mental health services?*

  • Parent Goals

  • If your daughter participates in ToGather Circle, what would you most hope she gains? (Check up to 5)*

  • Medical or Safety Considerations

  • How Did You Hear About ToGather Circle?*

  • Next Steps

    After reviewing your Interest Form, a member of our team will contact you to answer questions and, if appropriate, schedule a brief clinical screening to determine whether ToGather Circle is the best fit for your daughter.

  • By submitting this form, I acknowledge that additional paperwork or information may be required to complete my enrollment. I understand that a representative may contact me using the information provided to gather any necessary details. I also acknowledge that submitting this form does not guarantee a spot in the group, as availability may be limited. My participation will be confirmed once all necessary steps are completed.

  • I acknowledge the statement above:*
  • Should be Empty: