Along Your Journey, PLLC - Group Sign Up Form

Emergency Assistance

If this is an emergency, call:

Crisis Line: (844) 493-8255
911

Client Information

First name

Last name

Email address

Phone number

Date of Birth

I'm already an Along Your Journey, PLLC client

Name of your Individual/Family Therapist/Provider Check who you are seeing currently at Along Your Journey.

ShannonElaine John

My therapist is not listed

Are you actively in individual therapy elsewhere? (more than once a month)

Yes No

If yes, please list your therapists name

Your Consultation or Screening Availability

Date/s

Days of the week you are typically available

Time

Times of the day you are typically available for up to 15 minutes

Group Information

Additional information

If there's anything else that you would like me to know prior to your appointment, please include it here.

NOTE: Some groups are ongoing or "open" and you will be able to consult and join quickly. Some groups are "closed" which means they run for a set amount of time with the same people that started. Closed groups will start up again with new people on a set date and it may take some time to consult and join. Other groups are pending, accepting a waitlist and will need a certain number of people to start.

IMPORTANT: Submit you interest promptly in order to get in to the group you want as soon as possible.

Your information will be encrypted.