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Support Group Interest Form
Welcome!
Thank you for your interest in our women’s support groups. These groups are facilitated through Peaceful Resilience Counseling, and you may have found us through either Facing Giants or Peaceful Resilience Counseling—both founded by Caroline, a trauma-informed counselor, divorce strategy coach and advocate passionate about helping women heal, connect, and grow through life’s most difficult transitions.
Please fill out the brief form below so we can learn more about your needs and connect you with the group that’s the best fit for you.
I'm honored to walk alongside you.
Full Name
Full Name
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Email address
Email address
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Phone Number
Phone Number
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Preferred method of contact
Preferred method of contact
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Which group(s) are you interested in? (Check all that apply)
Which group(s) are you interested in? (Check all that apply)
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Mothering Through Fire
From Silence to Strength
Edge of Enough
Rooted & Resilient
I'm interested in more than 1
Other:
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What types of abuse have you personally experienced? (Check all that apply)
What types of abuse have you personally experienced? (Check all that apply)
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Emotional abuse
Verbal abuse
Psychological/Coercive Control
Physical/sexual
Financial
Legal
Unsure
Other:
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Do you have children? If yes, please list ages of kids.
Do you have children? If yes, please list ages of kids.
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Additional Info: Please share any specific needs, goals or questions you have about the group experience.
Additional Info: Please share any specific needs, goals or questions you have about the group experience.
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I understand these groups are supportive, psychoeducational spaces designed for women navigating experiences of domestic violence, coercive control or separation/divorce.
I understand these groups are supportive, psychoeducational spaces designed for women navigating experiences of domestic violence, coercive control or separation/divorce.
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I understand
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I understand these group are not for substitute for individual therapy or emergency services.
I understand these group are not for substitute for individual therapy or emergency services.
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I understand
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I understand this does not guarantee a spot in the groups nor does it establish a professional relationship.
I understand this does not guarantee a spot in the groups nor does it establish a professional relationship.
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I understand
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Peaceful Resilience Counseling has my permission to contact me at the provided email and/or phone number to discuss next steps.
Peaceful Resilience Counseling has my permission to contact me at the provided email and/or phone number to discuss next steps.
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Yes, at email address only
Yes, at phone number only
Yes, either email or phone number
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Signature
Signature
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