Group Registration Form — I.C.A.R.E Counseling Services, PLLC

Group Registration

Interested in attending the group workshops? Fill out some info and we will be in touch shortly! We can't wait to hear from you!

Name

First Name

Last Name

Email

Phone

(###)

###

####

What group are you interested in attending?

Women's Self-Love Acceptance Group

Working Through Grief & Loss: Adults

NervoUS: Coping with Anxiety

Working Through Grief, Loss, and Separation: Teen

JOIN WAITLIST: Men's Group

JOIN WAITLIST: Pressure Points: Navigating Life's Stressors

Who is your insurance provider?

Do you have a current or prior diagnosis?

Have you had any prior treatment?

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