Pandemic Processing Interest Form
10 weekly sessions. Each session is 75 minutes long. There will be two separate groups.

Wednesdays 5:00-6:15pm pacific starting September 16th through November 18th 
Thursdays 12:00-1:15pm pacific starting September 17th through November 19th

Financial commitment: Chose your own rate based on your financial circumstances between $25-$100 per session.
If you have the means to pay a higher rate, it makes it so those with fewer resources are also able to participate. Fees are paid weekly after each meeting. Please note you will be charged for all sessions regardless of attendance. 

Please feel free to reach out with any questions: olivia@oliviabelknaptherapy.com
Email *
Group Flyer
Name (first and last) *
Which group day would work best for you?

(If you select either/no preference I will reach out to you about which group you've been placed in the week prior to start)
 *
Are you physically located in California? *
What are you hoping to get out of this group? *
Do you have any concerns about joining this group? *
What topics feel most important for you to discuss in the group? *

Based on your current financial situation, choose a rate between $25-$100 per session. Please pick one number, rather than a range. 

Please note you will be charged for all sessions regardless of attendance. 

 *
Are you able to commit to weekly group meetings for ten weeks? *
Informed consent paperwork will be sent via email the week before groups start. All informed consent paperwork must be completed by Friday September 11th. If paperwork is not completed, your spot in group may be offered to someone else.  *
Required
Where did you hear about the group? *
Required
Anything else you'd want me to know?
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