Request to Register | Parenting Anxious Kids

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Thank you for your interest in our workshop. To join our next Parenting Anxious Kids workshop, please provide your contact information and answer a few brief questions.

Information about our upcoming workshop:
August 5th - September 9th, 2025
Tuesdays from 11:00am-12:00pm CST

All groups are held virtually

Please note: Once we receive the information below, and confirm that you are a good fit for our workshop, we will send you enrollment paperwork to complete. Upon completion of the paperwork, we will charge your credit card for the first session ($75) to secure your spot, and you will receive a welcome email to confirm enrollment in our workshop.

Please call our office administrator at (515) 216-0679 or email at admin@anxietytreatmentonline.com if you have any questions or concerns.

Parent/legal guardian name (First and Last): *

Parent/legal guardian phone number: *

Parent/legal guardian email: *

Child's name:

Child's age:

Which state do you live in?

Which of the following are the primary concerns for your child (check all that apply)? *

Obsessive-compulsive disorder (OCD)

Panic attacks or agoraphobia

Health anxiety/hypochondriasis

Social anxiety

Specific phobias/specific fears

Separation anxiety

Generalized anxiety and excessive worry

Selective mutism

Avoidant restrictive food intake disorder (ARFID)

Other:

Required

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