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New Mexico Group Therapy Intensive with Aimee Hadfield
May 19-23, 2023
Air/Travel Destination: Santa Fe, NM or Albuquerque, NM
Contact us at 435-932-0078 or
aimee@aimeehadfield.com
This form is HIPAA compliant and all information provided is secure and confidential according to guidelines for Protected Health Information (PHI.)
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What name do you go by? (First and last)
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Your answer
Is your legal first or last name different? If so, what is it?
Your answer
What are your pronouns?
Your answer
What is the best email address for us to get ahold of you?
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Your answer
What is your phone number?
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Your answer
How would you like to be communicated with?
Phone call
Text message
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How did you hear about this program?
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Referral from a professional
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Nudge from the universe
Do you have a therapist, counselor, or other helping professional you regularly visit?
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Yes
No
No, but I have been in individual counseling before
No, but I have been in group therapy before
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Do you have specific goals or things you're wanting to explore during this intensive?
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