Assertiveness Training - Skills in Practice
This group will commence on Tuesday 31st May and run once a week for 6 weeks. Please fill up this form to indicate your interest for Group Therapy for the above topic. Once I receive your application, I will schedule a short call with you to get to know a little bit about you to understand if you will be a good fit for this group. This group will be facilitated by Urveez Kakalia, Counselling Psychologist (Advanced Certification in REBT, Albert Ellis Institute, New York; Primary Certificate in SST, IN Vivo; MA Counselling Psychology, SNDT University).
Sign in to Google to save your progress. Learn more
Email *
Full Name *
Contact Number *
Age *
Biological sex
These questions about biological sex, gender identity and pronouns help me to respect and be sensitive to your individual identities.
Gender you identify with
Pronouns you prefer
Please state why you'd like to be a pert of this group and what you expect to gain from it *
What is you current understanding of 'Assertiveness' or 'being assertive'? *
Are you a current client of mine? *
Have you been a client of mine in the past? *
Use this space to ask me any questions you'd like to clarify
I understand that this form is an application for my interest in joining group therapy. I give my consent to be contacted further by the group facilitator to initiate the screening process which is to find out if I am a good fit for the group. After the screening process and confirmation of time and day schedule of the group, I understand that I will have  pay upfront in full to make a 6 week commitment to the group if I choose to be a part of it. *
Required
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
GoogleForms
reCAPTCHA
PrivacyTerms
This content is neither created nor endorsed by Google.