Group Interest Form

Please submit the form below to sign up for any available groups. See the Groups page for more details about each group. Once you have submitted the form, you will be contacted about scheduling an intake appointment prior to joining the group.

Name

Please provide the name you would like me to use for you.

First Name

Last Name

What are your pronouns?

Phone

(###)

###

####

What is the best way to contact you to schedule an intake appointment?

What is your age?

Please describe your gender identity:

Please describe your race and ethnicity:

Please describe any accessibility needs or considerations you would like me to be aware of:

Please select which group you are interested in joining:

Do you live in California?

Are you currently working with a therapist individually?

The group fee is $75 per weekly session. A limited number of sliding scale spots are available for those who cannot access a group at the full fee. Please indicate the fee you are able to pay per session:

Do you have any previous experience participating in group therapy?

Please describe any previous experience with group therapy:

Due to the interconnectedness of our community, it is possible that some group members may know one another. Please indicate if there is anyone who you would be uncomfortable in sharing the group space with:

Please read and select each item below to indicate you've read the group expectations.

Group members are generally expected to:

attend group sessions weekly for the full hour

have camera on during sessions (short time off-camera is ok, i.e. finishing a snack)

attend sessions from a private setting

practice skills during the week between sessions

Please describe any concerns you may have about meeting the group expectations described above.

Is there anything else you'd like to mention?