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Workshops/Group Intake Form

Please fill out this form for your desired group interest

Identity & Cultural Background:  We ask about race, ethnicity, and cultural background to better understand and honor your lived experiences. This information helps us provide care that is inclusive and culturally responsive. You may indicate multiple options or leave this blank if you prefer.

Group Race/Ethnicity
Group Therapy Options
Soul Sessions

What brings you to join a group at this time? What are 1-2 specific goals you hope to work on in group therapy?

Have you ever participated in group therapy?

 (If your answer is ‘no,’ that’s completely fine, it will not affect your ability to join this group.)

Health Insurance Plan

Thanks for submitting!

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