M.A.D.E: It's A Girl Thang! Teen Support Group
Thank you for your interest. Please take 5-10 minutes to complete this form with your teen (12-17 yr old). This will give me some basic information that can assist me in pulling together people who will be a good match in the group. Once you have completed this form you will receive a link for the full application.

The group is FREE  and we do accept monetary donations to help us continue provided these groups for free for our Teen Girls. Paypal: Simone.Guillet@beyondbalancecs.com.
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Email *
First and Last name *
Date of birth *
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Parent/Caregiver Name *
Contact Information (phone number and email address) *
How did you find out about the group?
What are your hopes and aspirations in attending the group? (any personal goals)
What makes now the right time for you to attend a group (have you been encouraged by someone to attend)? *
Are you currently accessing individual counseling or specialist support services?
Clear selection
Does your counselor support your participation in this group?
Clear selection
Are there any current mental health difficulties or life circumstances that may impact on your participation?
To ensure that all participants are able to support each other and get as much out of the group as possible, we ask for a commitment to attend all the group sessions. However, we do understand that work/family commitments and unexpected events can sometimes interrupt plans. Do you anticipate any difficulties attending for the duration of the group? *
If "Yes" or "Maybe" is selected, please explain
We provide light refreshment as part of the group. Do you have any special dietary requirements?
Do you have any additional questions or concerns about the group that you would like to discuss?
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