Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Name *FirstLastPreferred name / pronounsAge / DOB (to confirm appropriate age group) *Email *Phone *Are you a student? If yes, where at?Availability: Can you attend all 6 sessions?YesNoWhat are you hoping to gain from this group?Are you currently in individual therapy?YesNoDo you have a current diagnosis or mental health concern? (optional) or current you Any accommodations or support needs we should be aware of?Emergency contact (name, relationship, phone)Are you having any current thoughts of suicide?YesNoSubmit
