Support Group Info 2024
Thank you so much for filling out this form for us to provide your free Support Group on our state chapter website! We at PSI-CT appreciate all that you do! 
Today's Date *
年
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月
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日
Name of Group (if any) *
Name(s) of Group Facilitators *
Contact Email *
Phone number for member contact (s) If applicable.
Registration Link (if any)
Where does your group meet? *
必填
If in-person where?
If online what platform? (ex zoom , google meets...etc)
What time is your group? Length? *
What day? *
必填
What frequency? *
必填
What is your profession? If applicable how does your profession or experience help you or your group members navigate the perinatal period?
Does your group target a specific population of people? If so what is the focus of the group? (ex.fertility, lgbtqia, bipoc, young moms) Tell me more about why you want to help this population.
Additional Comments
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