Brave Hope Counseling Group Interest Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Brave Hope Counseling Group Interest Form

This form is to indicate interest in the Transcend group at Brave Hope Counseling for parents and caregivers of transgender children and adults.

Are you a current or previous client of Brave Hope Counseling? *

Yes

Legal First & Last Name *

Preferred Name (if different)

Pronouns *

Date of Birth *

Email Address *

Phone Number *

Group therapy requires a brief intake consultation appointment prior to beginning group. The purpose of the consultation is to ensure the group will be a good fit. This group is intended for parents, parental figures, and/or caretakers of transgender and non-binary youth and adults. This group is confidential and trans-affirming. I acknowledge that a brief virtual individual consult is required as part of the group process. *

Yes

Other:

I acknowledge that this group is self-pay only ($25/session, $200 total for 8 sessions) and that using insurance is not an option for this particular group. Payment plans are available as needed. *

Yes

Other:

Attendance is essential for success. Are you able to commit to the full 8 week group process? (Monday evenings, 6:00pm-7:30pm March 2nd-April 20th) *

Yes

What age(s) is/are the transgender individual(s) in your life?

What are you hoping to get out of the group?

Are there any topics you are hoping will be covered in group?

Are you currently in individual counseling?

Yes

Other:

Clear selection

How did you learn about this group?

Thank you for completing the interest form! You will be contacted by our team shortly regarding next steps.

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of Brave Hope Counseling.

Does this form look suspicious? Report

Forms