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Attract the Love You Want - Therapy Group Interest Form

Dating isn’t just about finding the right person—it’s about understanding how you show up in connection.

This therapy group is for women in their late 20s to early 40s who want to feel more confident in dating, understand their relationship patterns and work towards connections that actually align with who they are.

Together, we’ll explore how attachment, emotional needs, self-worth, boundaries and nervous system responses shape attraction while learning practical, therapy-informed tools to date with more clarity, intention and self-trust.

This form is to help us assess interest and eligibility. Filling out this form does not guarantee you a spot in the group nor is it considered a final commitment to joining. If you are deemed a good fit for the group, we will follow up via email or phone to let you know about next steps. Thanks!
This group is led by Jessie Davis, Associate Marriage and Family Therapist #145593, Under licensed supervision of Michelle Cantrell (California / LPCC12896)

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What is your email address? *
What is your phone number? *
Communication preferences *
Your full name *
Your age *
In order to participate in this group you must be a resident of California. Please confirm below. *
What time works better for your for a 1 hour virtual group meeting? *
Which week would you prefer the group to start? *
To help assess if you are a good fit, please select whichever applies to you. You are not required to check all the boxes to be eligible.  *
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What prior experience do you have with therapy?
Are you currently in individual therapy?
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How did you hear about this group?
I understand that this is an 8-week group billed at $60 per session and totals to $480. I understand that the group is a closed, time-limited series and commit to attending every week. I understand that each participant is allowed one free no-show during the 8 weeks for emergency situations.  *
I understand that this is a private-pay group and is not covered by insurance.  *
By submitting this form via this web portal, you acknowledge and accept the risks of communicating your health information via this unencrypted email and electronic messaging and wish to continue despite those risks. By clicking "Yes, I want to submit this form" you agree to hold Michelle Cantrell Counseling harmless for unauthorized use, disclosure, or access of your protected health information sent via this electronic means. *
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