Mindful Moms Group Interest Form

Thanks for your interest in joining our Mindful Moms virtual group! Please complete the questions below. Once you submit this form we will review your information and reach out to you via email to schedule an intake phone call or zoom meeting which will be 20-30 minutes. During our call we will get to know you, answers any questions you have, and make sure group therapy is the right fit for you and your goals.

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What is your name? *
What is your email address? *
What is your phone number? *
How many kids do you have and how old are they? *
Do you have an individual therapist? If so what is their name and how often do you see them?
Have you ever done group therapy before?
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How did you hear about this group?
What topics are you interested in learning about and/or discussing in group related to being a mom?
Does Monday at 12:00 work with your schedule? If not what time would you prefer?
What days and times are you available for an intake call in the next couple of days? (This helps reduce the emailing back and forth to schedule our call!
Anything else that would be helpful for us to know about you?
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