New Patient Intake
New Patient Intake
P Support Group Registration
Enter the email address you wish to use for correspondence about the group, including instructions about how to log in. Many people do not wish to use their primary email or an email that shares their identity.
Please check the boxes below to indicate understanding and agreement to the following conditions:
I understand that the purpose of this group is to help reduce and control symptoms of Pedophilia.
I agree not to disclose my identity within group, especially to another group member.
I agree not to share things that would trigger other group members towards acting toward their symptoms.
I agree to discuss issues of child abuse, child pornography, victim grooming, or other potentially triggering subjects only generally, never specifically.
If I have a question regarding what is or is not appropriate to share, it is my responsibility to ask the therapist facilitating the group.
I agree not to attempt to contact other group members outside the group, or to try to learn their identity.
I understand that the therapist facilitating the group is unable to provide any crisis services. In the event of an emergency (mental health or otherwise) I will contact local emergency services.
In case of an emergency, including but not limited to suicidal intent, I know how to contact local emergency services, 911, 1 (800) 273-8255 (the National Suicide Prevention Lifeline) or other local mental health services.
I understand that should I violate the rules of group I will be asked to leave.
I understand that payment is required in order to continue participating in group, and there are no refunds if I am asked to leave group for cause.
Electronic Signature: Writing a statement of agreement will act as your electronic signature. Please write "I agree" below