DBT Skills Group Sign Up

Name *

First

Last

Email *

Phone Number *

Please check all that apply: *

Please check all that apply: *

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.

Phone