10- Week Women's Shame Group

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Starting January 3rd, 2023 | Tuesdays 9am-10am | In-Person | $30 per session (Intake billed separately)

Please complete this form to register for the Women's Shame Group. Once this form is completed and receive, you will receive an email welcoming you to our online Portal to complete the paperwork necessary to schedule your intake session. All Groups require a one-hour intake; billed separately.

First & Last Name *

Email Address *

Phone Number *

Date of Birth *

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By completing this registration form you are agreeing to be contacted by one of our clinicians to schedule an intake session. *

Yes

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