GRM Group Interest Form

🛟 GRM Group Program Interest (#29)

I appreciate your interest in participating in either an online or in-person Grief Recovery Group.

Before you fill out this form, note that to participate in the online group format, you will need a laptop, desktop computer, or iPad-sized device and a strong internet connection to see other participants on your screen and complete the program effectively.

CONTACT INFO

_________________________

First Name

Last Name

Cell Number

INQUIRY DETAILS

_________________________

Do you prefer online (via Google Meet) or in-person (if local to me in ND)

Enter any questions or concerns below regarding meeting in-person or online.

Why do you to want to participate in the Grief Recovery Group Program?

Proposed date you'd like to start the group program.

Is Your Date Flexibile?

Yes

Somewhat

Your Location & Time Zone

LOGISTICS + BUDGET

_________________________

Budget Range

How did you hear about me?

Best Way To Respond

Phone

Either

Today's Date / Time

Thank You!

I look forward to potentially supporting you through this amazing, educational, and evidence-based program.

If you'd like to connect online, you can find me on Instagram | LinkedIn | Facebook.

GRM Group Interest Form

I appreciate your interest in participating in either an online or in-person Grief Recovery Group.

CONTACT INFO

INQUIRY DETAILS

LOGISTICS + BUDGET

Thank You!

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