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Group Counseling Sign Up
Please complete this confidential form completely and accurately so that we can serve you in a timely fashion. Thank you!
1. Are you currrently a client of Freedom Support Services? If no, continue to question #3.
3. Do you plan on using insurance?
5. Which insurance company do you have? (Please note: We only accept plans for the insurance companies listed below.)
4. Will you be physically bein the state of VA during the time you will be receiving services?
7. Have you been screened for and/or admitted to a pyschiatric facility within the last 12 months?
8. If there are no openings available, would you like to be added to our waiting list?  

9. Please select the group(s) you would like to attend:

 

Groups:
10. If there are no openings available, would you like to be added to our waiting list?  

Thank you for your interest in our groups. We have a high volume of requests and strive to respond to all requests for services within 2 business day. If you do not hear back from us, please send a courtesy email to contact@myfreedomss.com. Thank you!

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