Group Form | Christine Miller, LCSW

What Group Are You Interested in attending?*

Name*

Last name*

Phone Number*

Your email*

How would you prefer Christine to Contact you?*

Phone Call

Text to your phone number

Email

Do you have any questions or want Christine to know anything additional?*

I understand that I will need to have an intake session with Christine prior to attending groups. If your insurance is accepted, it will cover this intake session. This session is used to intake important information for insurance, establish your needs and goals for group therapy and to allow Christine to meet you prior to group sessions. This intake session does not need to be repeated for multiple groups at this practice.

Yes, I understand I will need one intake session prior to group therapy

Group Interest Form

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