Rouse Group Interest Form
Full Name
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What do you want to address in our group? (Please limit your response to 1-3 sentences)
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Which group(s) are you interested in learning about?
(Select all that apply)
Anxiously Intimate Men's Group
Finding Calm in Chaos
Chronic Illness Process Group
50+ Queer Men's Group
Anxiously Intimate - Queer Men's In Person Group
Intimate Partner Violence Support Group
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Are you interested in our other services?
(Select all that apply)
Individual Therapy
Couples Therapy
Sex Therapy
Group Therapy
Dating & Sex Coaching
Retreats
Couples Intensives
Ketamine-Assisted Psychotherapy
Brainspotting
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Phone
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Email
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State
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Insurance
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I understand that Rouse is in network with United and Optum until July, 2025. Otherwise Rouse can help with paperwork for out-of-network reimbursement with most other insurance providers.
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