Group Therapy Introductory Questionnaire
Thanks for showing an interest in being a participant of this 10 week therapy group.

Your answers to the following questions will help us to assemble a working therapy group.

Questionnaire responses will be stored securely, used only for the purpose of assembling and coordinating the therapy group, and will be destroyed no later than the end of year 2021.
Sign in to Google to save your progress. Learn more
Name: *
Date of birth: *
Email address: *
Phone number: *
Are you currently working, or have you previously worked with, a counsellor or psychotherapist? *
Have you had previous experience with group therapy? *
What is your reason for seeking group therapy at this time? *
What do you hope to achieve and/or change from attending this group? *
Are you concerned about your ability to keep yourself safe from harm (from yourself or others) during the course of the group? *
If you answered 'yes' to the question above, what supports do you have in place to manage this risk?
Is there anything else you would like us to know about yourself in relation to participation in a group of this sort? This could include, but is not limited to, things like accessibility requirements, cultural considerations, particular anxieties or concerns.
I understand that *
Clear form
Never submit passwords through Google Forms.
This form was created inside of Talk, Inc. Counselling. Report Abuse