Sanctuary Counseling, LLC.
610.385.3155 610.850.8009

Group and Program Registration Request

At Sanctuary Counseling, we value your privacy and confidentiality. We use your provided information for our group and program rosters, to contact you to verify your enrollment, and to notify you for a preliminary consultation to determine if our groups/programs are appropriate for you.

Your information will not be sold, exchanged, transferred, or given to any other company for any reason whatsoever, without your consent, other than for the express purpose of delivering the purchased product or service requested.

Once you have requested registration via this form, we will contact you as confirmation. One of our therapists will connect with you as soon as possible to confirm your enrollment.

As with all contact you have with Sanctuary Counseling, your inquiry today is completely confidential, and your information will be kept completely private.

Name

Child's Name (if applicable)

Email

Phone Number

I would like to register for the following group(s):
 TRIBE: LGBTQ Teens Support Group (Douglassville) LGBTQ Adults Support Group (ages 30+) (Douglassville)

When is the best time to contact you?

What is your preferred method of contact?

May we identify ourselves as calling from Sanctuary Counseling when we call?

If we do not reach you directly, may we leave a message?

If you can, please tell us a bit about what's going on:

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