IDG Wellness Program Interest Form
Please fill out this form if you are interested in our weekly discussion circles, classes, or free individual, couple, and family counseling. We will follow up with you by phone within the week to talk about what you're interested in! If you need immediate assistance call the NYC Well Mental Health Hotline at 1-888-692-9355 or dial 911.
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What IDG Wellness programs are you interested in? *
Required
First Name: *
Last Name: *
Phone Number: *
Email: *
ZIP Code *
Preferred Language: *
Are you able to complete counseling and/or discussion circles in English? *
What is your TLC license number? *
How do you prefer us to contact you? *
Is there anything else you'd like us to know?
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