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Group Interest Form
Please let us know which group you are interested in
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Email
*
Your email
Groups
*
Pet Grief Group
Art Therapy Workshop for Teens (Arabic-speaking)
General Grief Group
Relapse Prevention Group
Other:
Name
*
Your answer
Email
*
Your answer
Phone Number
*
Your answer
Preferred Contact Method
*
Email
Phone
Text
Required
Which times work best for you?
*
Morning (8am - 12pm)
Afternoon (12pm - 4pm)
Evening (4pm - 8pm)
Weekend (Saturday or Sunday)
Required
Preferred Session Format
*
Virtual (online)
In-person (Flower Mound, TX)
No Preference
Required
Would You Like to Be Added to the Waitlist for Any of These Groups?
Yes, please add me to the waitlist for available groups.
No, I would like to be contacted before being added to a waitlist.
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Are You Interested in Using Insurance or cash pay?
I have Aetna Insurance
I will pay cash
I am interested in a group packages
Insurance plan
United/Optum
Aetna
Cigna
BCBS
BCBS of MA
Medicare
Other:
Clear selection
Do You Have Any Questions or Additional Notes You'd Like Us to Know?
Your answer
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