First Name *

Last Name *

Date of birth *

Phone *

Email *

What motivated you to join this group therapy program? *

What specific challenges are you currently facing as an expat? *

Are you currently experiencing any of the following:

Difficulty sleeping

Changes in appetite

Feelings of isolation

Anxiety about cultural adaptation

Work-related stress

Relationship challenges

What do you hope to achieve through these group sessions? *

Have you participated in therapy before? If yes, please briefly describe your experience. *

Please indicate your preferred days/times for weekly sessions (please list 3 options). Times are in EST *

Monday 19:00 - 20:00

Monday 20:00 - 21:00

Wednesday 9:00-10:00

Wednesday 10:00 - 11:00

Wednesday 11:00 - 12:00

Wednesday 20:00 - 21:00

Friday 9:00 - 10:00

Friday 10:00 - 11:00

Are you comfortable participating in video calls? *

Yes

Can you commit to attending all 8 weekly sessions? *

Yes

What strengths or experiences could you bring to the group?

How comfortable are you sharing personal experiences in a group setting?

Very comfortable

Somewhat comfortable

Not at all comfortable

What concerns, if any, do you have about participating in group therapy? *

Do you have any specific topics you'd like the group to address? *

Are you comfortable providing a video testimonial after completing the program? *

Yes

Is there anything else you'd like to share or ask?

By submitting this form, you agree to receive text messages and emails from Melina Linden related to group therapy sessions, updates, and communications. Your consent is not a condition for services.

Note: All information provided will be kept strictly confidential and used solely for the purpose of group formation and therapy sessions.