Interest Form for Sibling Support Group

An 8-week group for 6th-8th graders who have a sibling with health, mental health, developmental disabilities, or other special needs.

Please correct the errors described below.

Please complete this secure form to help me better understand you and your tween. Please note: completing this form does not guarantee a spot in the group nor constitute a therapist-client relationship. You will receive an email response from Liz Gray within 24-48 business hours. Please add liz@lizgraycounseling.com to your address book. Thank you!

All questions refer to the tween you would like in the sibling support group.

8-week group is Tuesdays from 5-6pm 3/5/2019 through 4/23/2019

Thank you! Make sure to click "SUBMIT" below and please add liz@lizgraycounseling.com to your address book.

- Liz Gray, LCSW, RPT

Completing this form does not guarantee a spot in the group nor constitute a therapist-client relationship. If at any time during the process of completing the form, 15-minute phone consultation, or the intake session I am unable to offer your child a spot in the group, I will discuss other options (which may involve outside referrals). If there are not enough members who sign up for the group, I will discuss additional options with you as well. Thank you for understanding!

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