Destination Therapy | SimplePractice

Destination Therapy Request an appointment

Client Preferences

Which group times could work for your child? Please select several if possible.

Tuesdays from 6:00-7:30pm Tuesdays from 7:00-8:30pm Fridays from 5:00-6:30pm Fridays 6:00-7:30pm

Has your child ever expressed thoughts of harming themselves?

(e.g. self-harm, suicidal ideation, etc.)

Limited to 600 characters

Has your child ever expressed thoughts or plans to severely harm others?

Limited to 600 characters

Has your child ever engaged in self‑harm behaviors?

If so, when did this last happen? How frequent? What support do they have in reducing or stopping this behavior?

Limited to 600 characters

Is your child currently experiencing any of the following?

Severe anxiety Depression Panic attacks Emotional dysregulation

Has your child ever had a psychiatric hospitalization or participated in intensive treatment?

If so, please tell us when, why this treatment was sought after, and how successful it was.

Limited to 600 characters

Is there anything you feel hesitant or concerned about regarding your child's participation in group therapy?

Limited to 600 characters

If you are divorces, do you have a custody agreement or court order for the child who would be participating in this group?

Yes No N/A

For medical emergencies, contact your healthcare provider or call 911. For mental health crises, call or text 988.