Parenting Psychoeducation Group Application

Name *

First Name

Last Name

Email *

Phone *

(###)

###

####

Service Facilitator Name and Contact Info *

Do you have the best availability during the weekdays around 12pm, or after 6pm for eight one-hour sessions? *

12pm weekdays

After 6pm weekdays

Both work for me

Neither work for me

Can you commit to all eight sessions? *

Yes

No

Do you have access to Google Meet? *

Yes

No

Do you give permission to share your contact info with others from the group who want to connect with you? *

Yes

No

What are your top three needs as a parent? *

What barriers do you have to meeting those needs? *

What have you done as a parent to meet your child’s needs, what worked and what hasn’t? *

Can you attend with your parenting teammate or support person for your own work as a parent? *

Yes

No

What do you think a parenting psychoeducation group looks like or will be like? *

Do you need to chat with a psychoeducation group leader prior to the first session? *

Yes

No

Is there anything else we need to know? *

Thank you! A member of our team will be in touch shortly.

Our Locations

Reedsburg Office:
2560 E. Main St, Reedsburg, WI 53959
Entrance is in back of building.

Tomah Office:
1021 N. Superior Ave, Suite 10, Tomah, WI 54660

Waunakee Office:
1001 Arboretum Drive, Suite 110, Waunakee, WI 53597

Phone Number: (608) 886-9023

Fax Number: (608) 200-2417

Mailing Address:
PO Box 454, Waunakee, WI 53597