First Name *

Last Name *

Email *

Phone *

What age are your children who would attend a group. (Choose as many as apply)

7-10 Years

10-13 Years

14-16 Years

16-18 Years

What topics would you like group therapy to cover (Mark as many as apply)

CBT (How emotions, thoughts, and behavior work together and impact our mood)

DBT (Skills for increasing mindfulness, emotion regulation, crisis management, and relationship skills)

Teaching about emotions and how to cope with them

Social skills: how to make and keep friends

Coping with Divorce

LGBTQ+ support and processing group

What time of year is best for your child to participate in group therapy? Summer Fall Winter Spring

Summer

Autumn

Winter

Spring

If summer is an option for your family, what time of day in the summer is best for your child to attend group therapy?

9:30 to 10:30 AM

10:30 to 11:30 AM

1:30 to 2:30 PM

3:30 to 4:30 PM

4:30 to 5:30 PM

If you child would benefit from a group during the school year what time of year is best for your family?

Autumn

Winter

Spring

Are you interested in parent support groups?

Yes

What parent support groups would best fit your needs?

Supporting children with symptoms of anxiety.

Supporting children with symptoms of ADHD.

Building a positive relationship with your child.

How to help your child cope with emotions, support attachment, and build resiliency.

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