Adolescent Social Skills - Group Interest Form
Please include your contact info below if you are interested in joining the group "Adolescent Social Anxiety." An intake staff from Blossoming Cherry Mental Health Counseling will reach out to you to confirm and schedule you for the next upcoming group.

Reach out with any questions at (516) 256-9523 or info.blossomingcherry@gmail.com.
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Adolescent Name *
Adolescent Date of Birth *
MM
/
DD
/
YYYY
Parent Name *
Are you interested in an IN PERSON or ZOOM group?  
Parent Phone number
Parent Email *
Can your child commit to attending at least 8 sessions of this group?
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Group session will run for 1 hour.  Please indicate if you would be available to attend a one-hour group session during any of the blocks of times below. Select all that apply.
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
9am-12pm
12pm-3pm
3pm-5pm
5pm-7pm
7pm-9pm
Is your child currently seeing an individual therapist at Blossoming Cherry Mental Health Counseling?
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