Perinatal Mental Health Group Registration

We are glad to see you are interested in our perinatal mental health education and support group! This group is intended for expectant parents who are looking to acquire new tools and learn new skills to help support their growing family.

- The group begins on January 30th, 2024 and runs for 8 consecutive Tuesdays
- The group runs from 12-1pm via zoom (zoom link will be provided upon registration)

Please provide the following information to complete your registration.

First and last legal name

Preferred name (If different from legal name)

Phone Number

Email address

Address

If you are willing, please describe a little about where you are currently at in your pregnancy (e.g., how far along? how are you feeling? what has been going well?)

Is there anything else you would like me to know at this point?

Statement of Consent:

I consent to voluntarily participate in this perinatal mental health education group that is being facilitated by Hannigan Counseling Center, PLLC. I understand that my participation in the group at large and my participation in specific group meetings is entirely voluntary and I have the right to withdraw at any time without any penalty or consequence. I acknowledge that I have been provided with information about the purpose and expectations of the group. I understand that this group is not psychotherapy and should not be construed as such. I understand that any personal information shared during the group discussions will be kept confidential to the extent allowed by law. I agree to respect the privacy and confidentiality of other group members. I am aware that this group will meet via zoom and that although appropriate care will be taken to ensure confidentiality and privacy, confidentiality and privacy can never be guaranteed in technological spaces. I agree to pay the non-refundable course fee of $100 prior to the start of the group.

By checking this box, I, the above named person, have read and do agree to the statement of consent.

Your information will be encrypted.