Name
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First Name
Last Name
Email
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Phone
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What town do you live in?
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How did you hear about our groups?
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Check the boxes for any groups that would be of interest to you?
Do you have ideas for groups you would like to see offered here?
Do you have access to reliable wifi, a smart phone, and/or a place to safely meet via telehealth?
Our goal is to eventually offer both online and n person groups when it is safer to do so. If the group you were interested in were online, you would need to have reliable wifi and a safe/private place to meet. Some clients use smartphones, some use computers. Some have private rooms to meet in and others meet in cars, or offices, for example, in order to have a confidential space to talk. We are open but want to make sure you have a plan that works for you!
If a group you were interested in were to happen in-person, are there any barriers you think might affect your ability to participate? If so, please let us know so we could try our best to plan accordingly!
(Ex: health, transportation, anxiety, etc)
Do you have any cultural or other identities that are important to you? If so, please tell us more.
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Have you ever participated in a support group or skills group before? If so, what was it? What did you like about it/not like about it?
Are you currently or have you ever been involved in any individual therapy? If so, what did/do you like about it? What don't/didn’t you like about it?
Do you identify with having any sort of mental health diagnoses? If so, what diagnoses and what sort of support do you have/need?
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Is there anything else you feel is important for us to know at this time?
Thanks for your interest and for sharing your thoughts!
Thank you for sharing your thoughts and interest in future groups! If you haven’t already signed up for our newsletter, please do so here so that we can notify you as different opportunities arise at North Coast Connection.
In the meantime, if you have any further questions, you may find more information on different pages on our website, including our FAQ’s and our Resources pages.
Kind regards,
Em & Jenny
