NC Mom's in Bloom - Support group survey

Demographic's & Disclaimer

This support group is designed to provide a safe, confidential, and supportive environment where participants can share experiences, gain insight, and receive emotional support. The group is facilitated by a licensed therapist, but participation in this group does not constitute individual therapy or establish a therapist–client relationship outside of the group setting.
The group’s purpose is educational and supportive in nature. It is not a substitute for professional mental health treatment, diagnosis, or crisis intervention. If you are currently experiencing a mental health crisis or require individual therapeutic support, please contact your therapist, a local mental health provider, or emergency services immediately.
All members are expected to maintain confidentiality regarding what is shared within the group. However, please note that the facilitator is legally and ethically required to break confidentiality in cases where there is a risk of harm to self or others, or as otherwise required by law.
By joining this group, you acknowledge that you have read, understood, and agreed to the above terms. This group is in partnership with Keep Counsel.
1.Legal First & Last name(Required.)
2.What is the address where you currently live?(Required.)
3.Best phone number and email(Required.)
4.Please provide your date of birth(Required.)