Support Group Registration
Preferred Name *
Your answer
Preferred pronouns *
Your answer
Phone number (we require this to pre-screen for the group): *
Your answer
E-mail address (We- will contact you via this e-mail to plan group participation): *
Your answer
Have you attended a group before? *
Do you have any current mental health needs? If yes, please describe. Include if you're currently in therapy or other support services. *
Your answer
What types of SW have you participated in? (everything is confidential)
Your answer
What would you like to get out of a SW support group setting? *
Your answer
What's your availability for group? *
Midday
Weekends
Mornings
Evenings
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