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Emotional Regulation: A DBT Skills Group
Ages 12-18
WEDNESDAYS @ 6pm
16 week block sessions
Contact
groups@embark-counseling.com
with any questions.
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Email
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Teen's Name
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If you are registering more than one child, please complete an additional registration form.
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All Parent's/Guardian's Name and Phone Numbers
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Address
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Teen's Date of Birth
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Does your teen have any allergies?
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Does your teen have any special needs or accommodations requests?
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Is your teen currently seeing a counselor/therapist?
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If you answered yes, please provide your counselor/therapist's contact information below.
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Form of Payment
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Credit Card (you will be emailed our CC authorization)
Check (Embark must receive payment 2 weeks prior to start date)
Insurance (email
info@embark-counseling.com
to see if your insurance covers this group)
Paying per session or in full?
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In Full - $544 (savings of $96)
Per Session - $40 (16 week commitment)
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