Therapy Group for Black Women & Femmes

Question Title

* 1. Name

Question Title

* 2. Email Address:

Question Title

* 3. Would you prefer the group to be held inside or outside?

Inside

Outside

No preference

Question Title

* 4. Are there any weekend days in July or August that DO NOT work for you?

No

Yes

If yes, please list dates

Question Title

* 5. Are you currently vaccinated?

Yes

No

Other (please specify)