Support Group Registration Form for Survivors of Sex Trafficking
Welcome!

Thank you for reaching out to us in your journey of healing. We are so grateful to be able to offer you support. You will be contacted within 48 hours after submitting your form, but if you have any questions, please feel free to contact us at:
contact@ufhd.org or (832) 304-0832.

We look forward to connecting with you.
Sign in to Google to save your progress. Learn more
Email *
Name (First, Last) *
Preferred name
Cell phone *
Which support group would you like to register for? *
Required
If you are a Survivor Leader, please describe your leadership role and what organization you work for or volunteer with? What is your experience as a Survivor Leader? (If this doesn't apply, put "N/A") *
*
Required
Date of birth *
MM
/
DD
/
YYYY
City, State, Zip code *
Gender Identity *
Pronouns *
Required
Please check all that apply. *
Required
Do you have children? *
Required
Are they in your custody/care? *
Required
Would you prefer to meet virtually or in-person? *
Required
How did you hear about this group? *
Have you participated in a recovery program? If yes, which one? For how long? *
Are you currently working with a mental health professional (therapist, counselor, social worker)? *
If you're not currently working with a mental health professional, would you like a referral? *
Required
Other support groups you attend. *
What support could you use?
Additional information you would like to share.
If you were to pick an animal that describes you, what would it be? *
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy