group therapy registration

Complete this form to submit your registration for our therapy groups. Please note that all potential group members (or their parents) will complete a brief phone screening by one of our therapists prior to payment for registration. This ensures goodness of fit, allows us to get to know each other a bit, and gives you a chance to ask any questions as well as get a fuller picture of our group therapy offerings. We look forward to welcoming you!

*Please note that while we request payment in full by group start date, we also offer payment plans to make group therapy more accessible. Just let your therapist know if you are interested in this option. We are considered out of network for insurance but can offer you a superbill at the end of the trimester that you may submit to your provider for possible reimbursement. HSA/FSA cards welcome!

Client Name *
Client Name
Parent Name (for minor clients)
Parent Name (for minor clients)
Phone *
Phone
I understand that a therapist will contact me upon registering to complete a required free 15-minute pre-screen phone call to ensure goodness of fit. *
I understand that a non-refundable $50 deposit will be required after this call to hold my place in group. Payment for group series is due in full by the group start date unless I arrange a payment plan with my therapist. *
I understand the refund policy: Full refund less $50 deposit with cancellation at least 21 days in advance. No refunds after group start. In very rare circumstances, therapists may determine that a higher level or different modality of care is needed and will make that recommendation as appropriate. In this instance, a prorated refund will be given for any groups not attended. *
I understand that I am committing to attend the fall session and will make every effort to be present at each group meeting to support group cohesion & connection, and to get the most out of my group therapy experience. *
I understand that prior to joining group my therapist will discuss coordination of care with me and any other treating providers *