Join one of my group programs

Name *

First Name

Last Name

Phone *

(###)

###

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Do you struggle with sadness, anxiety, or anger?

Yes

No

Have you been to therapy before and haven’t gotten the results you wanted?

Yes

No

Do you struggle with emotional triggers and don’t know how to overcome them?

Yes

No

Do you want healthier relationships with the people in your life?

Yes

No

Which group program do you want to be a part of of? *

Heal the Child Within

Healing Adoption