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About
Services
Contact

Men's Speak Flyer.jpg

6 Bi-Weekly Sessions:

October 2, 16, 30

November 13, 27

December 11

Location:
New Venture House, 3rd Floor

3 Mill Creek, Road

Pembroke, HM05

$25 Per Person / Per Session

This is a closed group, so persons must commit to the 6 bi-weekly sessions.

Sign Up Today!

First name*

Last name*

Email*

Phone*

How long ago did your loved one die? *

Have you had counselling before?*

Yes

No

Have you been diagnosed with a mental health issue? *

Yes

No

If you answered yes to the above question, describe your diagnosis below?

Have you ever attempted suicide? *

Yes

No

If you answered yes to the above question, describe them below?

Do you have any food allergies? *

Yes

No

If you answered yes to the above question, describe them below?

Do you have any accessibility needs, health considerations, or special requests we should be aware of?*

Yes

No

If you answered yes to the above question, describe them below?

I am committed to attending all 6 bi-weekly sessions

Emergency Contact Name*

Emergency Contact Number*

Emergency Contact Relationship*

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About
Services
Contact

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