Group Interest: DBT Skills for RTW

1

Are you currently off work due to an injury, physical, or mental illness?* This field is required.

YESNO

2

How long have you been off of work?This can be with Layla or with another service provider.

0-6 months

6-12 months

12-24 months

24+ months

3

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

4

How did you hear about us?

Online seach

Family or friend

Family Doctor

Other health/wellness professional

Insurance company / Rehabilitation Consultant

Other

5

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

6

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

7

Name* This field is required.

First Name

Last Name

8

What pronouns do you use?

She/her/hers

He/him/his

They/them/theirs

Specify here

9

Email* This field is required.

example@example.com

Confirm Email

10

Phone Number

Area Code

Phone Number

11

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

YESNO

12

Thank you for connecting with us! Layla's The DBT Skills Group for RTW aims to empower individuals with relevant emotional regulation skills, interpersonal skills, and confidence to reintegrate into the work environment successfully and navigate the challenges that may arise during this transition. From what you have shared, the program may not be the best fit at this time.

You may be interested in Layla's 12-Week DBT Skills Group which provides DBT Skills training in a general setting. 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.

13

Groups - SF integration only

DBT Skills for RTW

14

Salesforce integration only

Interest Form Complete