PDA Parenting Support Group Interest Form

PDA Parenting Support Group Interest Form

Emen Counseling Services, LLC - Demand Aware Practice
For full program details, please visit emencounseling.com/pdaparentingsupport
Full Name

First NameLast Name
Email Address
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Residence

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Connections to PDA, (select all that apply)

Other
Other (please indicate your connection to PDA)
What age group are you interested in receiving support around? (select all that apply)
How familiar are you with PDA (Pathological Demand Avoidance / Pervasive Drive for Autonomy)?
What do you hope to gain from joining a PDA Parenting Support Group
Please share relevant information on your children and family. This may include ages, gender identity, specific needs, etc.
Group Topics

Each of the EIGHT group gathering focuses on 1 general topic, although connections are made across topics. Please indicate below which topics feel relevant to you at this time. **Topics covered will be prioritized based on largest interest in those attending**.
Please indicate your priority topics.
Preferred Scheduling

Other
Scheduling Constraints or Notes
Anything we should know about your availability?
GROUP STRUCTURE & CONFIDENTIALITY

This group will be structured as a combination of information on PDA, neurodivergence/adhd/autism, etc. from a licensed therapist, collaborative discussion and support with other parents, as well as optional regulation practices.

Group members are asked to agree to confidentiality for what is shared with the group.

I understand that submitting this form does not constitute group enrollment. Liz, at Emen Counseling Services, LLC will follow up directly to discuss next steps.
Please indicate your acknowledgement of the need for confidentiality. A confidentiality form will be provided for signature before attendance.
I would like more information about this group. Please indicate any questions you have or the information you are seeking before you feel ready to join:
How did you hear about our PDA Parenting Support Groups?

Other
Prefer to ask questions face to face or by phone? Book an intro call!
Should be Empty:

PDA Parenting Support Group Interest Form

Group Topics