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* 1. Are you interested in beginning small group therapy sessions for those experiencing chronic pain/illness? More info here: https://ichoosegrit.com/group-therapy/

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* 2. How often could you attend in person? (11124 N Cedarburg Rd, Mequon)

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* 3. How often could you attend, if done virtually? 

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* 4. What timing/day is best for you?

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* 5. What are you willing to pay? (I am a private pay clinic to allow for more freedom--with flexible pricing while beginning my practice)

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* 6. Age:

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* 7. What type of health issue (s) are you dealing with? (location of pain, diagnoses, etc.)

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* 8. Email address for future communication:

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