Seeing Through the Lens of Infertility Psychotherapy Group Sign Up
Please complete this form in its entirety. Your answers to these questions help group facilitators ensure that this group is a good fit for your needs. A group facilitator will contact you to discuss next steps following the completion of this form.
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Email *
Group Details
Group Dates: Mondays. September 27, October 4, 18, 25, November 1, 8
Group Time: 4:00pm - 5:30pm
Group Cost: $450 for individuals or $750 per couple
Group Location: Join virtually from anywhere in Texas
First and Last Name *
Zipcode *
Date of Birth (mm/dd/yyyy) *
What is the best phone number for us to call regarding your request? *
Do you consent to receiving voicemails regarding your request? *
Please describe your gender
Are there any other identities that you hold which you'd like us to know about? (Sexuality, ethnicity or race, physical ability, etc.)
Please describe your hopes or goals as they relate to participation in this group *
Please describe any past experiences with individual or group counseling *
Briefly describe your mental health history and any diagnoses you may have received *
Briefly describe your fertility journey up to this point *
Do you plan to participate as an individual or couple? *
After you submit this form, a group facilitator will contact you to set up a free 15 minute phone call. The purpose of this call is to ensure this group is the best fit for your needs. What days and times (M-Th, 9am-5pm) are best for a facilitator to contact you? *
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