INTERESTED IN JOINING OUR GROUP CLASSES?

Name:

Email:

1. Which groups are you interested in attending?

Depression and Anxiety Group (CBT)Addiction Recovery / Relapse Prevention GroupGrief and LossLGBTQ Support groupSubstance Abuse Disorder (SUD)IOP – SMIFirst Responders Support GroupNot sure / Would like help choosing

2. What are your primary concerns or symptoms?

Depression / low moodAnxiety / excessive worryTrauma / past difficult experiencesSubstance use / addictionStress managementRelationship difficultiesEmotional regulationOther

If other, please explain:

3. What skills would you like to develop?

Coping skills for anxiety or depressionManaging difficult emotionsMindfulness / staying presentImproving relationships and communicationReducing substance use / preventing relapseUnderstanding how thoughts affect feelingsBuilding motivation and healthy habitsOther

If other, please explain:

4. Please indicate the time of day you would attend groups:

Mornings (9am–11am)Afternoon (1pm–3pm)Evenings (5pm–8pm)

5. Have you attended a therapy group before?

YesNo

If yes, what was helpful or not helpful?

6. Is there anything else you would like us to know about your needs or preferences?