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Phobease Online Adult Anxiety Group Registration
Phobease Online Anxiety Groups will begin as soon as we have 8 adults enrolled. We use the HIPAA compliant version of Google Meet.
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Email
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Your email
Which 10 week Phobease Online Adult Anxiety Group would you like to register for?
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Tuesdays 8pm-9pm
If you will be using a PPO type of insurance, which one is it? If you wish to self-pay, it costs $500 for 10 one-hour group sessions.
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BCBS PPO
AETNA PPO
CIGNA PPO
UBH/UHC/Optum
Self Pay, $500 due on the first day
How will you be attending?
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Virtual Only at This Time, Using Google Meet, Due to COVID 19 Restrictions
What is the age of the participant?
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18+
Gender
Female
Male
Trans*
Prefer Not To Say
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Please provide participant's name
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Your answer
What's the best way to contact you?
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Call me on the phone
Text me on my cell phone
Email me
If you chose to be contacted by phone call, what number is best?
Your answer
If you chose to be contacted by text, what number is best?
Your answer
If you chose to be contacted by email, what email address is best?
Your answer
I will be emailing a few registration forms for you to fill out, and sending you the complementary workbook by U.S. Mail. What is the best mailing address to mail it to?
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Your answer
A copy of your responses will be emailed to the address you provided.
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