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“Over It” Ditching Overwhelmed Motherhood Therapeutic Group Registration

$260

This is a brief but intensive therapeutic support group environment that will encourage each participate to identify what is keeping them feeling stuck and unable to catch a breath, providing them with the tools they need to dig themselves out of it.

In order to protect the process and comfort of the participants in this environment it is limited to 4 participants.

Please complete the form below to reserve your space. This in-person group is composed of 4 once a week sessions. It begins Tuesday January 9th and will hold its last session Tuesday January 30th in Ventura, CA. Once your registration is complete intake paperwork and group access information will be emailed to you via Simple Practice.

***Babies up to age 1 are welcome to join.

Name

First Name

Last Name

Date

YYYY

Phone

(###)

###

####

Radio

I agree to electronic billing for the total $260 cost of this program.

Yes

I need information about a payment program.

Questions? Comments. Concerns?

By submitting this form via this web portal, you acknowledge and accept the risks of communicating your health information via this unencrypted email and electronic messaging and wish to continue despite those risks. By clicking "Yes, I want to submit this form" you agree to hold Caring Connection Counseling harmless for unauthorized use, disclosure, or access of your protected health information sent via this electronic means.

Yes