Group Availability Survey | Maplewood Counseling and Wellness

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Group Availability Form

Please take a moment to fill out the form.

1. What group(s) are you interested in joining? (Check all that apply)

Skills group

Apostates Club

Spoonies Support

2. What times of day could realistically work for you to attend a group (via telehealth)? (Check all that could work — no commitment!)

Early morning (7–9 AM)

Mid-morning (9–11 AM)

Lunch hour (12–1 PM)

Early afternoon (1–3 PM)

Late afternoon (3–5 PM)

Early evening (5–7 PM)

Later evening (7–8:30 PM)

Weekend (Saturday morning or afternoon)

5. What name and email can we use to follow up with you? (Optional)

Thanks for submitting!

First Name

Last Name

Email

Phone

Thank You for Reaching Out!

Full Name

Email

Thank You for Subscribing!

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