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Women's Virtual ADHD Group
CONTACT FORM
Please complete this form and one of the group facilitators will be in touch shortly!

Your Name (and pronouns if you would like to include)

Your Email

Your Phone Number (Optional)

How did you hear about this group?

Do you currently live within New York State?

Which set of dates for this weekly group would work best for your schedule?

Do you anticipate being able to attend at least 7 out of 8 group sessions?

Which of the following applies to you?

What would you be most hoping to gain from this group?

Is there anything else you would like us to know about you?

May we add you to our email list? (We send very few and will never share your information with others) * Required

Yes, sure

No, thanks

Thank you for your interest! We will respond to you within 1 - 3 business days.

Live Your Truth Mental Health Counseling, PLLC 917-268-2520 info@liveyourtruthcounseling.com

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