LGBTQ+ Allyship in Action Wait List Form
Information
  • Groups will be held weekly, but you do not have to attend every week
  • At this time groups are only open to individuals 18+
  • Cost $20.00*
  • Optional price $40 ($20 will be set aside to provide free attendance for someone in need)
By filling out this form you are acknowledging you understand the following:
  • While Dr. Bartel is an actively licensed clinical psychologist these groups are supportive in nature and do not represent an established clinical relationship. This means no client/therapist relationship is formed by participation/attendance 
  • The information provided to me in groups is only educational and does not constitute the provision of medical, psychological or other professional health care treatment services. Groups are also not meant to replace any medical or mental health treatment, whether this be therapy or medication management.
  • If at any point you feel you are in a crisis please call 988, text TALK to 741741, or go to your local emergency room
About Each Group:
LGBTQ+ Allyship in Action (for LGBTQ+ folx and allies): There is power in community. Whether you're an ally or part of the community, this group seeks to amplify and uplift those who believe in LGBTQ+ folx. This group will also serve as a space for allies and LGBTQ+ folx to come together to share what actions really matter and how we can all continue to be supportive of one another, even in the toughest and scariest times. 

*At this time Dr. Bartel is unable to offer pro bono/waived support group fees, but does hope to have a scholarship option in the future. 
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Email *
Legal Name (First & Last)
Chosen/Affirmed Name
What pronouns do you use?
What labels do you use to describe you gender?
What labels do you use to describe your sexual orientation?
Address
*
Phone number *
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