Group Dates: Mondays. September 27, October 4, 18, 25, November 1, 8 Group Time: 4:00pm - 5:30pm Group Cost: $450 for individuals or $750 per couple Group Location: Join virtually from anywhere in Texas
First and Last Name *
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Zipcode *
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Date of Birth (mm/dd/yyyy) *
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What is the best phone number for us to call regarding your request? *
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Do you consent to receiving voicemails regarding your request? *
Please describe your gender
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Are there any other identities that you hold which you'd like us to know about? (Sexuality, ethnicity or race, physical ability, etc.)
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Please describe your hopes or goals as they relate to participation in this group *
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Please describe any past experiences with individual or group counseling *
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Briefly describe your mental health history and any diagnoses you may have received *
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Briefly describe your fertility journey up to this point *
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Do you plan to participate as an individual or couple? *
After you submit this form, a group facilitator will contact you to set up a free 15 minute phone call. The purpose of this call is to ensure this group is the best fit for your needs. What days and times (M-Th, 9am-5pm) are best for a facilitator to contact you? *