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Group Therapy Interest Form
Thank you for your interest in group therapy through Coastal CBT New England, LLC! We are excited to offer groups virtually to adults in MA, CT, NH, and FL. Please complete the fields below if you would like to be contacted in the future about available group offerings. Please understand that this does not guarantee participation in future groups, as further screening would be completed prior to participation. If you are no longer interested in being contacted, please call or email us and we will remove your name from our contact list. 

If you are a provider or a parent of an adult child, please do not fill this form out on behalf of your patient or child. You are welcome to enter your own information below to learn when groups open up. 

Insurance: Dr. O'Bryan is in-network with Aetna and its subsidiaries, Carelon and Providence Health Plan, Anthem BCBS Connecticut, Anthem BCBS New Hampshire, and BCBS of Massachusetts. Patients with all other forms of private insurance are required to self-pay for services; however, Coastal CBT New England uses Thrizer for interested self-pay clients, permitting a co-pay at the time of treatment rather than the full out-of-network cost for those who have met their deductible. 

**By proceeding with the form below, you are indicating you do not have any form of Medicaid or MassHealth, or a a Medicaid or MassHealth ACO/MCO.**
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Your full legal name: *
Please tell us if you (patient) like to be called by another name.
Please select:  *
What is your phone number?
Is it okay to leave a voicemail at this number? *
What is your email address?
Is it okay to send you an email at this address? 
(While we cannot guarantee the security of electronic communications, we use a HIPAA-compliant encrypted email service called Paubox.)
*
Please select any that apply: *
Required
Please feel free to share any notes about your availability here. You must have access to a private room and secure internet connection.
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