DBT Skills Group - Wait list/Interest Form
Thank you for your interest in our DBT Skills Group at Radical Healing. To help us maintain a list of interested folx, please complete the following form. We hope to have a 2nd group up and running September/October 2018.

PLEASE NOTE: Since this form is transmitted electronically, confidentiality cannot be guaranteed, If there is any question you prefer not to answer, please let us know by completing the last form response and we can schedule a time to meet with you over the phone or in person.

Name *
Your answer
Pronouns *
Your answer
Phone Number
Your answer
Your answer
Do we have your consent to... *
How did you hear about us?
Your answer
Do you have preference for meeting times?
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