Addiction Recovery Group Interest Form

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Recovery Group Interest Form

I am interested in participating in an online addiction recovery group *

Yes

I would like more information

When would you prefer to meet online? (check all that apply)

Weekday Mornings

Weekday Afternoons

Weekday Evenings

Weekend Mornings

Weekend Afternoons

Weekend Evenings

How much would be a fair price for a 1x weekly support group led by a professional in addiction recovery?

$20-$25 a week

$26-$30 a week

$31-$35 a week

$36-$40 a week

$41-$45 a week

$46-$50 a week

$51+

Clear selection

How much would be a fair price for a 2x weekly support group led by a different professional in addiction recovery each meeting?

$31-$35 a week

$36-$40 a week

$41-$45 a week

$46-$50 a week

$51-$55 a week

$56-$60 a week

$61+ a week

Clear selection

Would you prefer to pay monthly for a discount?

Yes

Clear selection

Do you prefer attending only one group or would like like the option of multiple groups per week?

One group per week is good for me

I would like to attend more than one group each week

I would like the flexibility of attending one or more group as needed

Clear selection

Please leave phone and or/ email if you would like to be contacted about group support.

Submit

Clear form

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