Group Interest Form

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Maplewood Counseling & Wellness

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Please take a moment to fill out the form.

1. What are you most hoping to get out of a group experience? (Check all that apply)

Learning new skills (e.g., emotion regulation, distress tolerance, communication)

Connecting with others who “get it”

Support for a specific struggle (e.g., anxiety, ADHD, trauma, burnout)

Accountability for growth and change

A more affordable alternative to individual therapy

Something else: ___________

2. What times of day could realistically work for you to attend a weekly 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)

3. What format would feel most helpful right now? (Choose up to 2)

A short skills series (4–6 weeks)

A longer process group (8–12+ weeks)

Ongoing support group (open-ended)

Drop-in sessions (single-topic mini workshops)

Not sure — I’d love to talk more

4. If there’s a specific topic you’re most interested in, let us know! (Optional — e.g., grief, boundaries, burnout, emotion regulation, neurodivergence, trauma recovery)

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

Thanks for submitting!

Questions? Connect with Us

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Last Name

Phone

Thank You for Reaching Out!

Email: emilyhansen@maplewoodcounseling.com
Phone: (425) 324-9055

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