Group Application

Complete the following

Once you submit this application, a group facilitator will be in touch with you within the next 48 hours.

Name *

First

Last

Name *

First

Last

Email *

Phone Number *

I am registering for... *

Tribe - A Group for Guys Adoption Support for Individuals & Couples Haven - A Group for Women DBT Skills for Women

How soon are you prepared to begin group? *

one week one month undecided

What interests you in this group? *

How did you find out about the group? *

Submit

The Yellow House
(Neurofeedback)
1307 Hixson Pk.
Chattanooga, TN 37405
(detailed directions w/pictures)

(o)423.517.7070

(f)423.208.9022

e-mail About

neurofeedback