Centennial Peaks Hospital
Group Submission Form
Select One:
This is a NEW group that is not currently listed on the site
This is an UPDATE to a group that is already listed on the site
This is a group that you would like us to DELETE from the site
Therapist Name:
*
Credentials:
*
Contact Phone:
Email:
Web Site:
Title of Group:
Group Location:
Date(s) of Group:
Group Description: 1 to 2 sentences including gender/age specifications):
Category for this group (select up to three)
Addictions
Adjustment Disorders
Aging
Anger Management
Anxiety/Panic Disorder
Bipolar Disorder
Career Issues
Children's Issues
Coping Skills
Creative Groups (art, movement, writing)
Depression
Dialectical Behavioral Therapy (DBT)
Dissociative Identity Disorder (DID)
Divorce/Separation
Domestic Violence
Eating Disorders/Issues
Equine Therapy
Family and Friends Support
Financial Issues
Firesetting
Gay, Lesbian, and Transgender Issues
Grief and Loss
Medical Illness/Disability/Pain
Men's Issues
Mood Disorders
Obsessive/Compulsive Disorder (OCD)
Parenting/Pregnancy
Personality Disorders
Phobias
Psychotherapy
Relationships/Intimacy
Self-Improvement/Personal Growth
Senior Issues
Sexual Abuse/Assault/Issues
Sleep Issues
Spiritual Groups
Sports Groups
Teen/Adolescent Issues
Trauma
Wilderness/Outdoor Groups
Women's Issues
Cost/Fees:
Sliding Fee Scale?
Yes
No
Insurance Accepted?
Yes
No
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