INQUIRY FORM

Therapy Group for Grownups Raising Neuro-Diverse Kids

Thank you for your interest in our Parent’s Therapy Group.

This psychotherapy group, designed for individuals doing the unique work of parenting neuro-divergent kids, meets biweekly on Wednesdays from 10:45am to 12:00pm. Each 75-minute in-person session is facilitated by Lisa Kays in the D.C. Metro Area. Your investment for this group is $100 per session, which is payable whether or not you attend. This rate is intended to foster committed attendance and is subject to change annually. If you are interested in joining this group and find that a lower rate would make it feasible for you to attend without creating a financial burden, there is space to specify this on the form below. We recommend participating in group for a minimum of six months as it takes time to settle in, learn how to make the best use of it, and address your therapeutic concerns. Beyond six months, you may remain in group for as long as it still feels aligned. Because of this, the group may have rolling entries and exits.

If all of the above works and you’re ready to join group, we invite you to complete the form below.

Important: This group is intended to support you, not teach you how to parent your kids. For parenting support, visit Raising Orchid Kids. Please note that neither Lisa Kays PLLC nor this therapy group is affiliated with Raising Orchid Kids.

Patient Information

Name

First Name

Last Name

Pronouns

Email

Phone

(###)

###

####

Location

Referred By

Group Participation

What are you hoping to get out of this group?

Are you the only parent who is interested in joining this group?

I am the only parent interested in joining this group -OR- I am a single parent.

My co-parent(s) is/are also interested in joining this group, and has/have submitted a separate inquiry form.

My co-parent(s) is/are also interested in joining this group, and has/have NOT submitted a separate inquiry form.

If you were referred by your therapist, SLP, or OT, do we have your consent to contact them so that we may assess if this group is a good fit for your needs?

Yes

No

If you are interested in joining this group and find that a lower rate would make it feasible for you to attend without creating a financial burden, please let us know so that we may discuss this further with you.

What additional information (if any) would you like us to know to evaluate if you are a good fit for this group?

Communication Preferences

Please check this box if you would like to be added to the Lisa Kays email list.

SUBSCRIBE

Form Submission

While we make every effort to maintain the highest level of security across all platforms we use at Lisa Kays PLLC, please note that electronic forms of communication are never 100% secure. Please also note that we collect, process, and store your data according to our Privacy Policy and that submitting this form constitutes your full understanding of and agreement with these terms.

Please read our Privacy Policy at www.lisakays.com/privacy.

I UNDERSTAND

By submitting this form you are confirming that all of the following works for you: (1) Biweekly group sessions on Wednesdays from 10:45am to 12:00pm; (2) 75-minute in-person sessions facilitated by Lisa Kays in the D.C. Metro Area; (3) $100 per session rate or an alternative per-session rate you specified above for consideration, which is payable with or without attendance; (4) Commitment of six months minimum.

I CONFIRM

Therapy Group for Grownups Raising Neuro-Diverse Kids

Thank you for your interest in our Parent’s Therapy Group.

If all of the above works and you’re ready to join group, we invite you to complete the form below.

Everyone is welcome here.