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Anxiety and Depression Support Circle

First name*

Last name*

Phone*

Email*

Address*

Birthday*

Month

Day

Year

Briefly describe your anxiety/depression symptoms:*

How long have you been experiencing these symptoms?*

Are you currently seeing a mental health professional?*

Yes

No

Have you attended group therapy for mental health before? *

Yes

No

What days and times work best for you to attend group?

Groups are currently being formed. You will be contacted by our Peer Support Specialist within 48hrs of submitting this form. Thank you very much for reaching out.

© 2023 by The RAC

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