6-Week Youth Social Media Group
Tuesdays | 5:00-6:00pm | May 3rd-July 19th | Ages: 8-18 (pre-high school graduation)
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Please complete this form to register for the Youth Social Media Group. Once this form is completed and receive, you will receive an email welcoming you to our online Portal to complete the paperwork necessary to schedule your intake session. All Groups require a one-hour intake.
Youth ages 14+ are in charge of their own mental health care in the state of Oregon. Please include their contact information.
Youth First & Last Name *
Youth Email Address
Youth Phone Number
Youth Date of Birth *
Parent First & Last Name
Parent Phone Number
Parent Email Address
By completing this registration form you are agreeing to be contacted by one of our clinicians to schedule an intake session. *
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