Facts & Feelings Group Interest Form

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Thank you for your interest in joining Facts & Feelings, a support group for caretakers of gender diverse kids at Mangata Wellness!

This form is intended to gather additional information about your specific needs and interests. Please complete the questions below and submit the form at your soonest convenience. One of our clinicians or administrative staff will then be in contact to collect a couple more details and confirm your group enrollment.

*Please note that space in this group is limited!! If we receive your form after the group is full, we will contact you to see if you would like to be added to our waitlist for the next round of Facts & Feelings, which will begin in January 2024. We appreciate your understanding and look forward to meeting you soon!

Please provide your full name (first and last) and preferred pronouns (e.g., Kay Smith, she/her) *

Are you or your child currently a client at Mangata Wellness? *

Yes, I am a client

Yes, my child is a client

No, I am not a client

No, my child is not a client

Required

How old is your child? *

Please briefly share why you are interested in the Facts & Feelings support group at this time.

Examples may include: learning more about navigating systems for your child (e.g., schools, healthcare, insurance), processing the questions gender transition brings up about your own experiences, addressing the fears and concerns about what gender transition means for your child, etc.

Please briefly describe what type of support you feel you need right now.

Examples may include: a safe space to ask questions about gender identity or the gender transition process, camaraderie with others who have shared lived experiences, concrete ideas for supporting my child's mental health, etc.

Please provide a good contact phone number *

Please provide a valid email address to send additional forms, information, and updates prior to the start of our group *

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