Mental Health Provider Support Group

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Group Meeting Date: 3rd Thursday of each month 2024 (5/16, 6/20, 7/18, 8/15, 9/19, 10/17, 11/21, 12/19)

Group Timing: Starts at: 12:00pm EST (run time: 50-60mins)

Group runs for: Indefinitely, drop-in status

Group Address: Virtually/Video Conferencing

Group Type: up to 10 participants per session, payment due 7 days before session

Email *

Name *

Date of Birth *

City, State, Country *

Phone Number *

Emergency Contact Info:

Name

Relationship

Contact #

Brief info about reasons for attending this group *

What you are hoping to get from this group? *

Would you prefer handouts/skills for managing demanding MH role? *

Yes

Maybe

Would you prefer just to be able to talk, vent, share about recent struggles with your MH role? *

Yes

Maybe

Payment: $30 per group (Due 5-7 days before session)

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

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