Group Therapy Sign Up Form
This form is used for group therapy sign up for the Unpacking the Conscious and Subconscious Mind Group workshops. This is a 6 week closed group, each week is $100 per session. You can pay in lump sum using a payment installment (AfterPay). Group sessions will run from April 11 through May 16 on Tuesday evenings from 6:00 PM - 7:30 PM and held virtually. For more detailed information about the group like cost, dates, times, access and locations, please email therapy@touchofpeacecounseling.com or call 301-660-2558. 
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First Name *
Last name *
Phone Number:  *
Email Address: *
Gender *
Age *
Do you have children? How many? *
Relationship Status *
What brings you to this group?
What do you hope to gain from this group?  *
Consultation Requests: Consultations for this group  are held on Mondays and Fridays from 11:00 AM - 1:00 PM and Wednesdays from 4:00 PM - 7:00 PM. Please provide your availability using the above listed time frames and we will follow up to confirm your requested consultation time. Consultations help to determine if this is the right group for you. I hope to meet you soon.  *
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