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Grieving a Loss Due to Overdose: Therapy Group Interest Form
This is a supportive group for adults in New York who have lost someone to overdose.
Some details:
We meet online for 90 minutes each week (with short breaks).
We meet for at least 6 weeks at a time (schedule is determined by group interest).
The weekly cost is Pay-What-You-Can, between $30-100.
There will be one free spot available, based on financial need.
Fill out this form if you want to learn more or sign up. I'll reach out to you with more information soon after you submit your form.
Warmly,
Joelle Fanciullo
(joelle@therapywithjoelle.com)
therapywithjoelle.com
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Email
*
Your email
Check this box if...
...you are a healthcare provider completing this on behalf of someone under your care (one person at a time, please).
I look forward to supporting you in your grief. Who have you have lost to overdose?
*
My sibling(s), step-sibling(s), or sibling(s)-in-law
My child(ren), step-child(ren), or child(ren)-in-law
My parent(s), step-parent(s), or parent(s)-in-law
My aunt(s) or uncle(s)
My cousin(s)
My grandparent(s)
Other family member(s)
My friend(s)
Other:
Required
How old are you?
*
Choose
Under 22 years old
22-25
26-30
31-35
36-40
41-45
46-50
51-55
56-60
61-65
66-70
71-75
76-80
81-85
86-90
Over 90 years old
If meetings are
online
, and
at the same time each week
,
for 6+ weeks
, which times would
probably
work for you?
(Scroll Left to Right to see all options - start times are from 10am to 7pm.)
10-11:30am
12-1:30pm
5:30-7pm
5:45-7:15pm
6-7:30pm
6:15-7:45pm
6:30-8pm
6:45-8:15pm
7-8:30pm
Mondays
Tuesdays
Wednesdays
Thursdays
Fridays
10-11:30am
12-1:30pm
5:30-7pm
5:45-7:15pm
6-7:30pm
6:15-7:45pm
6:30-8pm
6:45-8:15pm
7-8:30pm
Mondays
Tuesdays
Wednesdays
Thursdays
Fridays
Check this box if...
you require the free spot in order to participate in this group (you cannot afford the minimum of $30/week).
Is there anything else you'd like me to know, before I email you with more information?
*
Your answer
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