Perinatal DBT Group Interest Form
Thank you for your interest in the Perinatal DBT Group for pregnant and postpartum people with infants and toddlers up to 5 years old. This form is used to determine who is interested in group and times that you are interested in joining this group.
Name
First Name
Last Name
E-mail
example@example.com
Phone Number
-
Area Code
Phone Number
Location:
Maryland
Virginia
DC
Michigan
Other
Options for group times:
Morning (10:45am-12:00pm)
Afternoon (1pm-2:15pm)
Evening (7pm-8:15pm)
Brief description about your interest in this group:
Once we have enough interest, we will reach out to you about the next upcoming group. Please stay tune by email and our website (www.karimcounseling.org/group-therapy-for-moms/) for more information.
Submit
Should be Empty: