DBT Skills Group Sign UpPlease enable JavaScript in your browser to complete this form.Name *FirstLastEmail *Phone Number *I am interested in: *Adult group on Tuesdays 5-6:30 pmTeen group (ages 14-18) in Wednesdays 4-5:30 pmPlease check all that apply: *I am in individual therapy and my therapist recommended the group.I am not currently in individual therapy but I have been in the past 1-3 years.I have recently participated in PHP/IOP.I have never been in individual therapy .Please check all that apply: *I am brand new to DBT.I have participated in DBT Skills Training before.If you have previously participated in DBT Skills Training, please briefly describe the group you attended.Are you planning to utilize insurance benefits for DBT? *No, I will be paying for DBT by check, cash, or credit card due at the beginning of the group.Yes, I would like to use insurance benefits to pay for DBT.If you plan to use insurance benefits, please provide the name of your insurance company/plan.Please give a brief description of why you are seeking DBT treatment. *Please share any other questions or concerns you have about DBT so I can be sure to address them.EmailSubmit