The "Empowering You" Support Group Screening Questions
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Join Us for this 6- week group to receive support and guidance as you recover from dysfunctional relationships.
  • Support and guide members on their  recovery journey
  • Inspire hope by honoring the significance of members’ stories and making their group journey comfortable, insightful, and rewarding
  • Inspire hope by honoring the significance of members’ stories and making their group journey comfortable, insightful, and rewarding
  • Learn, develop , and implement effective coping mechanisms as well as strategies  to assist group members with responding to distressing experiences in a healthy fashion 
  • Developing more adaptive thinking strategies in an effort to enhance self-esteem and confidence
  • Develop boundaries to help remain in full control of life
  • Identify and/or develop effective support systems that would provide fulfillment in group member’s lives
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First Name and Last Name: *
Email Address: *
Phone Number:
*
Age:
*
Please provide your desired Pronouns
 *

Are you currently taking any medication(s)? If YES, Please provide the names and doses.

*

Can you commit to the group time (7pm)  on the following days June 28th, July 5th, July 12th, July 26th, August 2nd , and August 9th ?

*

 Were you diagnosed with any mental health conditions in the past ? If YES, Please specify.

 *

Are you currently diagnosed with any mental health conditions? If YES, Please specify.

 *

Do you have a history of alcohol and/or substance use? (If so, please indicate if past and/ or present and drug of choice.)

 *

Are you currently or have in the past experienced  any suicidal or homicidal thoughts?

*

Have you ever made an attempt to end your life or the life of someone else (past or present)?

*

Are you currently in therapy?

*
What are you hoping to get out of this group? *
Where did you locate our services?
*
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