Therapist Support Circle Inquiry Form "*" indicates required fields URLThis field is for validation purposes and should be left unchanged.Name*Email* Phone Number*Please indicate how you’d like me to respond to this inquiry Text Email Don’t care Are you a current or previous client of Bloom Therapy? If so, please name any past or current Bloom therapists who have provided you care.Because the circle is intentionally personal and emotionally open, we are thoughtful about maintaining clear boundaries between peer support and psychotherapy. Current Bloom Therapy clients are not eligible to participate while actively receiving psychotherapy at Bloom. Former Bloom clients may be eligible depending on the circumstances and whether participation would create an overlapping relationship or conflict. Participating in the circle does not prevent someone from receiving therapy at Bloom in the future. However, participants would not be matched with the circle facilitator or another Bloom therapist who simultaneously participated in the support circle.Date of Birth* Month Day Year Gender and/or PronounsDo you spend most of your time in Texas? If you live in another state and/or travel often, please provide details.*What is your preferred group meeting time?* 2–3 pm on Tuesdays (in person) 9–10 am on Thursdays (virtual) Both groups occur on a biweekly basis.If there is an ideal day or time for group please let us know to inform future group offerings. Additionally, indicate the frequency and format (IRL vs virtual) that you would like to see offered.What makes you interested in joining a therapist support group?*What are your expectations for the group? What do you hope to get out of it?How would you describe your greatest challenges in being a therapist?Group payment structure*The group is $20 a meeting with a minimum 8 meeting commitment that will be charged in one lump sum of $160 unless otherwise agreed upon by you and the group leader. However, if you would like to try one meeting before committing you can do so. You will be charged $20 for the first meeting and the subsequent $160 if you decide to continue. After 8 meetings, you are welcome and encouraged to continue attending and will be charged per meeting. By checking “Yes” below, you will indicate that you have read and agreed to the group pay structure. Yes Would you like to have a 10 min phone consultation with the group leader before signing up?* Yes No You are welcome to request a call, but it is not mandatory. The group leader may also reach out to talk with you before joining the group to determine goodness of fit.Are there any fellow therapists you would not feel comfortable or safe being in a group with?Is there anything else you would like me to know?How did you find the Therapist Support Group?
