Neurodiversity Support Group Registration
Join us for a free, virtual support group for neurodivergent adults to explore identity, relationships, and self-care in Texas.

When: Second Wednesdays, from 7:00 PM - 8:30 PM CST
Where: Virtual via Zoom
Who: Facilitated by Rachel Rungdit, LPC Associate, supervised by Jennifer Buffalo, LPC-S, LMFT

If you are in crisis, please call 911 --- 512-472-HELP or the National Suicide Hotline at 988.
First and Last Name *
What name do you go by? (if different than above)
Pronouns *
Required
Email *
Phone Number *
Preferred Method of Communication *
Required
Is it okay to leave a voicemail if we contact you by phone? *
Do you reside in Texas?

*note: You must be a Texas resident to participate in this support group.
*
Do you identify as neurodiverse or as someone within the spectrum of ADHD, Autism, or other neurocomplex identities?

*note: diagnosed, self-identifying, or ND-curious are all valid and welcome! 
*
Are you currently receiving any counseling or psychiatric care? *
Have you had any counseling or psychiatric care in the past? *
Are you currently experiencing suicidal thinking? *
What are you hoping to get out of this support group? *
Which groups would you like to be RSVP'd for? (every 2nd Wednesday)

you may attend any or all sessions! your selection will give you access to each session's call link the day before.

*each group will be unique with structure & open discussion according to the needs of the of attendees*
*
Required
How did you hear about us?
Is there anything else you'd like the group facilitator to be aware of?
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