Interest Form and Questionnaire: Grief Support Group

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To help us determine the goodness of fit for this group, please answer the questions below and we will reach out to you in 1-2 business days. Your information will not be shared with other group members.
Questions about this form or about group therapy? Please contact Abundance Therapy Center at 213-441-6780.

First Name *

Last Name *

Email Address *

Phone Number *

Please tell us a little bit about yourself (including your personal identity, culture, and age range). *

What interests you about this group? *

Are you currently a client of Abundance Therapy Center? If so, who is your therapist? *

This is an open support group meaning that it is voluntary and fluid (participants can join or leave at any time). Are you okay with this? *

Yes

What are your expectations for the group? *

How did you hear about the group? *

This is a support group that does not allow for insurance billing. Do you agree to self-pay for the group at $45 per session? *

Yes

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