Group Therapy Interest Form 
I run several process groups for California-based clients built around a common theme and shared demographics. This secure form is my way of collecting interest and getting connected so we can get you set up in a group that is a good fit for you. Once you fill out this form, you will be contacted by the therapist for a phone/Zoom screening to figure out next steps.
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Email *
Which of the following groups are you interested in? Use "Other" to share something not listed.
Which of the following categories/topics matter to you or do you have experience with? *
Required
The groups meet on Wednesdays PST. Which of the following time blocks could work and don't work for you? *
First choice
Second Choice
Third Choice
Definitely Can't
7:15am - 8:45am
9:15am - 10:45am
11:15am - 12:45pm
1:15pm - 2:45pm
3:30pm - 5:00pm
7:45pm - 9:15pm
If Wednesdays are an absolute no-go, what other days or times would you want to attend group during? *
What age group are you? *
What are you hoping to get out of a group like this? If there are any specific topics or suggestions you are hoping to find here, this is the place to share them. *
Is there anything else you want to share before we chat? *
What is the best email address to reach you at? (and/or cell # if you'd like to be texted/called, please specify) *
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