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14 Week DBT-Informed Skills Building Group : Request Intake Appointment or Learn More?
DBT Group Form
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First Name *
Last Name *
Name of client attending the group(s) *
Client's date of birth? *
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Email *
Phone *
Call or Email? What is the best way to reach you? *
How did you hear about us? *
Which group(s) are you interested in? *
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You may pay using health insurance or private pay (cost is $490 per person prepaid or $45 per group). If using health insurance, which health insurance will the person attending group be using? *
Is there anything else you'd like us to know before we reach out to you for a call? *
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