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Name
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Age
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Location
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Email
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Phone
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Do you identify as a member of the Global Majority?
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Yes
No
If so, how do you identify?
Selection: you you?
Are you currently in individual therapy?
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Previous group therapy experience (if any)
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What draws you to this group at this stage of your life?
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What would feeling more secure in yourself look like?
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Are there aspects of your identity (race, culture, immigration history, religion, sexuality, etc.) that you would want acknowledged or held with particular care in group?
Do you have any concerns about confidentiality or emotional safety in a group setting?
Group process includes exploring how you show up in relationship to others. Describe what “reflecting on your relational impact” means to you?
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Are you able to commit to consistent attendance for the duration of the group?
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Format Preference
In Person
Virtual
Group Selection:
Rooted + Rising
Whole + Becoming
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