Therapist Support Circle Inquiry Form

We’re gathering interest for upcoming Therapist Support Circles. Meeting dates and times will be determined based on participant interest and availability. Please share your preferred format and the days and times that work for you. Hayden will follow up as the circles take shape. Submitting this form expresses interest only; it does not enroll you in a group or authorize a payment.

"*" indicates required fields

URL

This 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

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 Pronouns

Do 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 meeting format?*

In person at Bloom Therapy

Virtual via Zoom

Either format / flexible

The schedule will be determined based on participant interest and availability. Please select your preferred format and share your availability below.

What days and times would usually work for you? Please list all options, your time zone, and how often you would like to meet.

Share any scheduling flexibility or constraints. We’ll use these preferences to plan the circles. If you’re not sure yet, you can still express interest.

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?

Payment structure if you choose to enroll*

These terms apply only if you choose to enroll after the schedule is confirmed. Submitting an inquiry does not enroll you in the group or authorize a payment. 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 acknowledge that you have read and understand the payment structure for future enrollment.

Yes

Would you like to have a 10 min phone consultation with the group leader before signing up?*

Yes

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?