DBT Group Interest Form

Please provide us with some extra information in order for us to learn if this group is the best fit for you. Once you submit this form your information will be sent to the group facilitators and they will contact you within 24 hours to gather any additional information needed.

Thank you!

Name *
Name
Phone *
Phone
(If yes, please specify disorder)
(If yes, please include most recent dates, length of stay, and name of facility)
(If yes, please provide their name and contact information) - We may require a release form to evaluate appropriateness for participation in this group
(If yes, please provide when and where)

We appreciate you taking the time to complete the above questions, once we have received your initial pre-screening, you will be contacted by a counselor from Seasons Counseling Orlando to complete the screening process for our DBT group.

Please note: If you do not currently have a therapist you are actively seeing, we will refer you to one of our counselors. Individual therapy is a requirement to be involved in our DBT groups.

We look forward to meeting you!