Eight-Week Depression Recovery Program

Your registration has been submitted!
REGISTRATION FORM

Select One:
One-on-One Meetings with Dr. C. at Hope Church
Schedule Small-Group Meetings with Dr. C. at your Church or Organization

Address: Hope Church
240 Wolfpit Rd                       
Wilton, CT 06897
   

Answer the following questions only if you selected One-on-One Meetings with Dr. C.

Have you previously been diagnosed with any mental disorder? (Select all that apply):
Depression
Panic Attacks
Obsessive Compulsive disorder
Bipolar disorder
Schizophrenia
Other pyschological disorder
Are you currently on medication or treated by a physician/counselor?
Yes No
Have you ever attempted suicide?
Yes No Are you considering suicide now?
Yes No