Group Therapy Interest and Feedback
Art Therapy Studios wants to offer art therapy group sessions that are specifically customized to fit the members needs. The following questions will provide the information needed to develop these groups and offer them to our community. The information collected in this survey will remain confidential and only viewed by Brenda Cunningham, MS, ATR-BC, LPC, for the sole purpose of developing appropriate group therapy services to our community. You may choose to remain anonymous, or you may provide your contact information at the end of this survey. Your information will not be shared. Thank you for taking the time and offering your input.
Art Therapy Studios
What is your gender?
What is your age?
Do you live or work in or near Hanover, PA?
How far would you be willing to travel to obtain art therapy services?
What is your profession?
What is your comfort level in a group setting?
Very uncomfortable
Most Comfortable
Are you currently involved or seeking treatment with other providers?
Were you referred by someone to join a group?
If yes, please specify the referral source:
Your answer
Do you have an existing diagnosis from a psychiatrist, psychologist, physician, or other evaluation?
If you know your diagnosis please specify here:
Your answer
What are the current concerns or issues in your life? Please check all that apply.
Specify other concerns or issues not listed above:
Your answer
What is your availability to attend a group session?
12:30pm - 3:30pm
3:30pm - 6:30pm
5:30pm-9pm
n/a
Mondays
Tuesdays
Wednesdays
Thursdays
Fridays
Saturdays
Sundays
What is your willingness level to attend a group session?
Not very likely
I am willing to commit to attending every session to help myself grow and feel better
There are 2 types of groups. OPEN= is a regularly scheduled meeting that is open for new members to join all the time, and is ongoing. CLOSED= is a group that has a set number of registered participants, those same members meet regularly for a predetermined number of sessions, and has an end date. Which type of group would you prefer?
Do you have any other comments, questions, or concerns?
Your answer
Please provide your name and contact info below ONLY if you would like to receive more information regarding services provided by Art Therapy Studios.
Your answer
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