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) * this aware of 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)Any accommodations or support needs we should be aware of?Emergency contact (name, relationship, phone)Are you having any current thoughts of suicide?YesNoSubmit
