Group Registration Form

reewew

Date / Time

Phone/Mobile

Preferred Method of Contact

Phone

Text

Text Input

Phone Number

Important Information & Acknowledgments

Please review and acknowledge the following:

I understand that participation in groups is voluntary

I understand that some groups may be offered as fee-based services and that payment details will be provided prior to participation, if applicable.

I understand that group schedules, availability, and topics may vary

I understand that groups are supportive in nature and may be accessed as a standalone service or alongside other services.

I understand that confidentiality is respected; however, confidentiality cannot be guaranteed in a group setting, and participants are encouraged to respect one another’s privacy.

Consent to Be Contacted

Checkbox Field

I give permission for Total Life Cares to contact me regarding group registration, scheduling, and related information using the contact details provided above.

Signature

Text Input

Date / Time

Support & Counseling Groups