Apply for "Healing Through Relations" Women's 50+ Group

Thank you for your interest! This short application helps us see if this group is the right fit for you. Once you submit it, Tara will be in touch to connect and set up a time to chat. Be sure to check your spam & email!

First name

Last name

Phone

Birthday

Month

Day

Year

Are you a current client at Eterna Counselling?

Yes, I am a client.

No, I am not a client.

Were you referred by a current Eterna client? If so, please share their first name and last initial (this helps us avoid conflicts of interest within the group)

No.

I'm not sure

Yes

If yes to the question above please name the person referring you. (First Name, Last Initial).

I have read and understand the group's payment and attendance policies, including that all sessions are billed regardless of attendance.

Yes, I have read and understand

No. What document?

Submitting this form doesn't guarantee a spot. This is the start of the interview process. During your chat with the facilitator, you'll figure out together whether this group's focus is the right match for what you're looking for right now.