For Women Only Trauma Processing Group

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This form is used for registering for the trauma processing group on Tuesdays from 1:30-2:45 beginning May 7, 2024. The group meets in person at 97 Main Street, Manchester, CT 06042.

The purpose of the group is to help members process thoughts and emotions that arise in daily life and are based on past life experiences. We will work on developing skills for emotion regulation, healthy communication, boundary setting and distress tolerance to improve coping with everyday stress/anxiety. This group allows for members to drop in when they need extra support without having to commit to coming every week.

Group can be billed to your insurance. Out of pocket costs would depend on your insurance policy. Private pay rate is $30/session. If cost is an issue please let us know! We never want finances to be a reason someone does not get the support they need.

Please fill out this form prior to attending your first group session. We look forward to working with you!

If you have any questions, please feel free to contact info@thelighthousemanchester.com or 860-470-6002 x700.

Email *

First and Last Name *

Phone Number *

Address *

Email Address *

Do you have a PTSD or other trauma-related diagnosis? *

Yes

I'm not sure

Are you currently working with a therapist? *

Yes

When is the first date you plan to attend group? We do not need advanced notice, but we like to have an idea of how many individuals will be attending, so this is helpful but not a commitment on your end. *

YYYY

What symptoms of trauma do you live with on a regular basis? *

Intrusive thoughts

Sleep disruption

Panic

Flashbacks

Dysregulated mood

Difficulty maintaining healthy relationships

Difficulty setting and maintaining boundaries

Difficulty being in public spaces

None of these

Other:

Required

What insurance do you have? *

Please check all that apply: I give the Light House permission to contact me using: *

Phone calls

Text

None, please do not contact me. I will come in person or call if I have questions.

Required

Are you interested in consultation phone call before joining the group? *

Yes

What are you hoping to gain by attending this group?

A copy of your responses will be emailed to the address you provided.

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