It's the Self-Awareness for Me
A few questions to get to know you, help you set your intentions, and to acknowledge the purpose for the group.
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A therapy group designed to connect deeper with self by creating more awareness of your inner dialogue, learning how to set healthy boundaries,  and taking steps towards the fulfilling life you dream of.
Full Name *
Age *
Birthday *
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Current Location *
List 2 thing you like about yourself: *
List 2 things about yourself that you currently struggle with: *
What are 2 areas where you desire to see growth? *
What is something you'd like to take away from this group? *
What is your history with and understanding of your mental health? *
What concerns do you have about being a part of this therapy group, if any? *
Personal Intention Statement: I am committed to doing my best to grow into someone who shows myself more kindness, compassion, patience, positivity, and love. I believe that I deserve great things and that I have the ability to mold the future that I desire. *
Required
Group Acknowledgment: I acknowledge that there is a confidentiality agreement between myself, the therapist, and everyone else involved in the group. Everything that is discussed within the group sessions will remain within the group sessions. Please fill in your name (first and last) to represent your acknowledgement and signature for the above statement. *
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