interested in joining?

Name *

First Name

Last Name

Phone

(###)

###

####

What session(s) are you interested in? Check all that apply

Upcoming session (March 2025)

Future Fall session

Future Spring session

What group format are you interested in? Check all that apply

Online

In-person (Roseville)

Ok with either format

What time do you prefer to meet? Please check all that apply

Weekday daytime (between 10a-2p)

Weekday late afternoon (between 3-5p)

Weekday evening (between 5-7pm)

How did you hear about the group?

Recommended by therapist

Recommended by friend

Psychology Today

Social Media

Magnolia Therapy & Wellness website

Other

Are you currently working with a therapist? Check all that apply

Yes, individually

Yes, with a couples/family therapist

No

What areas in your life do you feel could be improved by participating in the Setting Boundaries group? Check all that apply

Partner relationship

Relationship with child/children

Relationship with parent(s)

Relationship with friends

Experiences at work

Overcommitment

Burn out

Frustration

Feeling unheard

Ghosting/avoiding people or relationships

Cycles of conflict with others

Feeling used

Feeling unappreciated

Exhaustion

Stress

Anxiety

Depression

Other