Anxiety Group Inquiry Form

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Southern Maryland Mental Health is excited to offer adult and teen anxiety/social support groups! Please complete this form if you are interested in an adult or teen anxiety/social support group and would like additional information. Groups will only run if there is enough interest. There are in person and telehealth options available! Groups are $50/person per group

First Name: *

Last Name *

Email *

Phone Number *

Address *

Age *

How would you like to attend the group? *

virtual

in person

either

Please briefly describe the participant and what the participant hopes to learn/gain/accomplish from this group?

*

I am aware that this is not treatment for any specific mental health disorder, but an interpersonal process interaction group.
*

Yes I understand

How did you hear about this group?
*

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