Group Survey

1. Are you currently a patient at Insight Psychological Group? *

Yes
No

2. How did you first hear about IPG? *

Social Media (Facebook, Instagram, LinkedIn...)
Web search/Google
Recommendation of an outside provider
Recommendation from a current/former patient of IPG

3. We are currently enrolling clients in the following groups. Please check any that you're interested in joining or hearing more about: *

Youth Anxiety Course (including self confidence, social media/phone addiction, improving communication...) (Ages 13-17)
Struggling with Grief and Loss (for adults)
DBT Group (Dialectical Behavioral Therapy)(for those having trouble with mood regulation and relationships)
Something else (see next question)

4. Is there a topic that you are interested in discussing in a group that is not currently offered? If so, what?

5. Would you pay for group therapy or courses without insurance coverage? (approx $50-65 per session) *

Yes
No
Maybe

Tell us a little bit about yourself

6. What's your age and gender? *

If you are filling this form out for someone else, please provide their relationship to you, their gender and their age.

7. What specific issue(s) have you (or the person above) been struggling with? Please select all that apply *

8. When is the best time for you or the individual above to have group sessions? *

Morning, between 9am-12pm
Afternoon, between 12pm-4pm
Evening, between 4pm-9pm
Flexible

9. If you would like us to reach out to you about our current groups, or to keep you posted on new groups as they develop, please add your name and email address below.

Name

Email address

Tell us a little bit about yourself

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