Virtual Group Therapy Interest Form
Sign-up sheet for individuals interested in group therapy sessions.
Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Are you a current client of Introspection Counseling Center?
*
Yes
No
Have you ever participated in group therapy sessions before?
*
Yes
No
Will you be using insurance or self-pay for group therapy sessions? (Note: Self-Pay rate is $50 per session)
*
Insurance
Self-Pay
What is your state of residency?
*
Delaware
North Carolina
New Jersey
Thank you for completing the Virtual Group Therapy interest form. A Care Coordinator will be in touch soon to follow-up upon your request.
If you have additional questions please give us a call at (302) 213-6158 option 1 or email us at contact@introspectioncounseling.com
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