Group Therapy Registration Form

Group Therapy Registration Form
Registration for group therapy opens and closes when group occupancy limits are reached. Each group restricts the number of participants to 8. Our treatment groups are NOT walk-in groups. Participants who register will be expected to attend the group for the full duration of the sessions (typically 8 weeks).

Groups typically run for 8 weeks at a time before breaking. During this break, new participants are permitted to join. However, placement priority will be given to returning participants.

Groups may be canceled due to low participation or attendance.

If you are using insurance to cover the cost of your group treatment, you must complete a diagnostic evaluation with one of our clinicians before starting group treatment unless you present referring orders from a physician or other clinician with a diagnosis and signed treatment plan. You may still be required to complete a 30-minute consultation before being accepted into the group.
Participant Name

First NameLast Name
Participant Email
example@example.com
Participant Age
Some groups are restricted to age
Parent or Guardian

First NameLast Name
Parent or Guardian Phone
Please enter a valid phone number.
Please describe your current treatment status

Current Patient at New Millennial CounselingCurrent Patient at Washington Area Clinical CenterCurrent Patient of Another Provider (referred for group only)Referred from PHP, IOP, Court, Hospital, or other community serviceI am not connected with any provider, but I wouldn't like to beI am interested in group only and I am not in treatment somewhere else
Which group(s) are you registering for?

Trauma Group (Virtual)Trauma Group (In-Person)Grief and Loss Group (In-Person)Grief and Loss Group (Virtual)Adolescent Anger Management (Virtual)Healthy Coping Skills Group (Virtual)Coping with Anxiety: The Expressive Arts (In-Person)Men's DBT GroupOne-Time Specialty Topic WorksheetOther
How do you plan to pay for group treatment?

InsuranceCash, Credit, Debit, or Visa PaymentI am uninsured and unable to cover the cost of treatment
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