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Support Group Form
This form is to gauge interest in potential members
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Email
*
Your email
IMPORTANT NOTES
IMPORTANT: DVIP is an independent, non-profit organization that enforces it's own set of protocols, due to DVIP COVID-19 protocol, masks are REQUIRED for ALL participants in support group when levels are high.
- Every other Tuesday from 6pm-7pm
- Transportation not provided.
- Childcare provided for children 12 and under
What is your name?
*
Your answer
How did you hear about support group?
Your answer
Will you need childcare? (Note: childcare only provided for children under 12)
*
Your answer
If yes, how old are your children?
Your answer
Can you (basically) commit to a full session?
*
Your answer
Do you have access to outside support such as an advocate, counselor or physician for one on one issues?
*
Yes
No
No, but I would like to get connected
No, but I have other resources
Do you feel ready to listen, share, and explore thoughts and feelings around your trauma?
*
Yes
Not yet, but I am willing to try
What do you hope to gain from support in a group setting?
Your answer
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