Support Group Pre-screen

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All information received in this prescreening will remain confidential. The findings in this screening will be used solely by your facilitator to better provide you with the tools and support you need along your journey to healing & safer living.

Email *

Please check the box that best fits you. Would you like to be informed on the Sexual Assault Support Group details *

Please contact me regarding support group

I do not need support group at this time

Required

NAME (optional)

RACE (optional)

AGE? *

GENDER *

What is Sexual Assault? *

Could you share a little about your experience that brought you to seek support group?

(share only what you are comfortable with)

What are some of the ways you have coped when you have experienced distress?

What kinds of support have you had in the past to deal with what happened to

you?

(If you were interested)

When would be a perfect time for support group?

We just want to be sure you know that this is a group for support and skill-building, not a therapy group.

What are you expecting in a support group?

Send me a copy of my responses.

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