Healing Through Connection Group Interest Form

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Thank you for your interest in the Healing Through Connection Group. The next session of this group will begin on 12/7 and run for 12 consecutive Mondays from 11:30 am PDT - 12:45 pm PDT.

If you are interested in participating in a future session of this group, please fill out the information below to have a call with Dr. Cortney Beasley. These phone calls will happen on Mondays, between 11am -1pm PDT, or Tuesdays, between 11am -1pm PDT and are required for enrollment in the group.

Thank you, The Octave Team

Name: *

Pronouns: *

Date of Birth: *

YYYY

Email Address: *

Telephone Number: *

My Preference for a Call with Dr. Cortney Beasley is

Mondays, 11am - 1pm PDT

Tuesday, 11am - 1pm PDT

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