Mirielle Therapy Queer Support Group-- Interest Request Form
Queer Support Group

When: Every other Tuesday Evening Beginning July 11th, 2023
Where: Online via Zoom
Cost: $70 per session

Queer folks often feel like they don’t have a sense of belonging in many aspects of life. Through this group, a safe space is created where we can openly discuss and further explore identity, provide support, and foster a sense of community. These confidential discussions will help provide the necessary tools to enter the world with pride and ownership of identity.

The group is led by Emily Chernow, LMSW.

Please give your information below and we will contact you to discuss the group more and to see if it is a good fit for your needs!

Email *
What is your first name? *
What is your last name? *
What is your email address? *
What is a best phone number for you where we can leave a message? *
Have you been in a therapy group before? *
If you answered yes to the question above, please describe the group.
Do you currently live in New York State and will you be able to participate in the group from a New York State location. (Although the group will be held via ZOOM, we are only licensed to see clients who are within New York Sate). *
Group Therapy Sessions are $70 (Not open for Aetna Insurance). If able to join the group do you agree to this session  amount? *
What is your current gender and sexual orientation? *
Do you have any serious history of self-harm or mental health distress that would be helpful for us to know. We will ask more about this when we contact you. *
Thank you-- This group has space for a limited number of clients. Session fees are charged for any missed sessions made with less than 24-hour notice in addition absences can be disruptive to the group therapy process. If you are included in the group, Do you agree to make a commitment to keeping regular attendance with very few cancelations?  *
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