Group Interest: Recovery Skills Group

1

Program available to participants 18 years or older* This field is required. Layla's partner therapists for this program are licensed in Ontario. Therefore, this program is available only to residents of those provinces at this time.

2

Which Recovery Skills group are you interested in? - please notify Dev to integrate this question with SF* This field is required.

DATE

Not sure, want to speak with Layla

3

Name* This field is required.

First Name

Last Name

4

What pronouns do you use?

She/her/hers

He/him/his

They/them/theirs

Other

5

Email* This field is required.

example@example.com

Confirm Email

6

Phone Number

Area Code

Phone Number

7

May we leave a voicemail?* This field is required.

YESNO

9

Privacy of your information* This field is required.Layla respects your right to privacy. Please read our policy to understand how we collect and use personal information

10

Layla is not a crisis service* This field is required.If you or someone you know is in crisis or at risk of serious harm towards yourself or others, call 911 or go to an emergency room

11

Thank you for connecting with us! Layla's DBT Advanced Skills Roundtable is designed for individuals with previous experience with group or individual DBT therapy so the program is not a good fit at this time.

You may be interested in Layla's 12-Week DBT Skills Group which does not require previous training. Click here for more info.

If you would like our team to be in touch with you to discuss eligibility or other options, please click SUBMIT.

12

Groups - SF integration only

Recovery Skills

13

Salesforce integration only

Interest Form Complete