Overcoming Self-Injury for Adolescent Females 12 - 17
Fill out this form to register your daughter for group.  Once you have submitted the form, you will receive confirmation from Katie Overcash or Lynne Beck.  Further paperwork is required before beginning group.
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What is your daughter's name? *
What is your name? *
What is your daughter's birthday? *
Is your daughter currently in therapy? *
Has your daughter been involved in therapy before? *
Does your daughter have any mental health diagnoses?  If so, what? *
What are you looking for your daughter to accomplish in group? *
What is your email address? *
What is your phone number? *
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This form was created inside of Katie Overcash.