Event Registration: The Center for Trauma, Stress, and Anxiety

We're so excited you're interested in joining one of our groups, workshops, intensives, or events!

To express interest in one of our offerings, please answer the following questions so that our team can get you scheduled!

Registration:

Please select which group, intensive, workshop or event you would like to register for.

Mindful Masculinity: An 8-week group for men who are trying to live up to what society expects of them, but are miserable in the process.

This group therapy offering will meet weekly on Mondays from 6:00pm-7:00pm. The class will run from September 30th until November 18th.

You are perfect for this group if you are...

- Male-identifying

- Interested in exploring and developing your masculine identity further

- Feel pressured to fit the "masculine" mold and find it is damaging to your own well-being and to your relationships

- Find it difficult to identify and express emotions

- Often experience irritability, physical reactivity, and/or demonstrate aggressive behaviors

If any of this resonates with you, we have a group waiting for you! You are not alone.

By the end of the group, you will be able to sense a shift in the expectations you have of yourself as well as a shift in your perceptions around masculinity. As a result, you will be able to make conscious, mindful choices for how you want to show up for yourself and others in your masculinity.

Client First Name *

Client Last Name *

Client's Email *

Client's Phone *

Client Date of Birth

Other Relation to client

Is the registrant a current client of CTSA or new?

What is the legal guardian's relationship status?

Is there a custody agreement in place?

Yes

Other

Please list the Name, Relation, Phone, and Email for any ADDITIONAL parent or guardian that is responsible for decision making

Preferred method of contact: (Check all that apply) *

Phone

Other

Your Name:

Your phone number:

Your email address:

Your preferred method of contact

Phone Call

Text

Financing Information

If you would like to use your health insurance for our events, there's a few things you should know:

Our practice is In-Network with the following insurance plans:

CareFirst HMO, PPO, Federal & BlueChoice plans- (excluding Medicaid, Medicare, and EAP),
EverNorth- (excluding Medicaid, Medicare, and EAP)
John Hopkins EHP
John Hopkins USFHP

Please note: If your primary insurance is through an insurance company or plan not listed above, you are considered Out-of-Network or 'Self-Pay' at CTSA. If you choose to proceed with care as a self-pay client, we are happy to provide you with a 'Superbill' on a monthly basis that you can use to submit for reimbursement from your insurance provider.

_________________________________________

Medicaid clients only

Due to Medicaid guidelines, we cannot provide Out-of-Network services to Medicaid clients. To find a Medicaid provider near you, go to: https://encrypt.emdhealthchoice.org/searchable/main.action

Do you plan to use your health insurance for the event you are registering for?

My insurance is through:

BCBS/CareFirst

Cigna/EverNorth

John Hopkins EHP

John Hopkins USFHP

The policy holder is:

Myself

My Partner

My Parent

Other

The policy holder's information

My Member ID # Is:

My Group # Is:

Messaging Consent

Yes, I agree to receive text messages from CTSA. Message frequency varies and may include appointment reminders, session information, appointment scheduling, billing information, and promotional messages. Message and data rates may apply. Reply STOP to opt out.

No, I do not want to receive text messages from CTSA.