Group Registration Inquiry

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Thanks for taking the time to fill out the below information to join our group! Please know that this is only an initial registration form; registration is not confirmed until all consents have been completed through our secure online portal.

Email *

Full Name *

Phone number *

Which group are you interested in participating with? *

Parenting Thrill-Seeking Teens

Gaining Serenity

Which days/times are you most interested in meeting? (please select all that apply) *

Tuesdays at 6pm

Thursdays at 6pm

Saturdays at 1pm

any/no preference

Required

By submitting this form, you are consenting to receive information regarding group therapy offerings provided by Tempest Therapy Services, LLC/Jessica Moody, LCSW. Please be aware that your registration is not confirmed until all consents have been completed. Contact us directly at jessica@tempesttherapyllc.com should you have additional questions or concerns not otherwise addressed in the consent agreements.

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