Have you been directly or indirectly impacted by gun violence?

Yes

No

Prefer not to say

Are you currently receiving individual therapy or mental health support outside of this group?

Yes

No

Are you available to attend weekly sessions on Saturday mornings in Bowie, MD?

Yes

No

Maybe

I understand this is a confidential, closed group facilitated by a licensed therapist.

Yes

I understand that participation is voluntary and this is not a crisis service.

Yes

I agree to maintain confidentiality and respect for all group members.

Yes

I understand that payment of $40 per session is due before or at the time of service.

Yes