Intake

Group Member Data

Name

First Name

Last Name

Page in book

Address

City

Zip

Phone

(###)

###

####

Group Name

Group Type

Group Facilitators

Group Start Date

YYYY

Referred by

Initial response to Client

YYYY

OB Provider/Hospital

Therapist

Baby's Name

First Name

Last Name

Baby's Date of Birth

YYYY

Notes

Beyond the Baby Blues

Beyond the Baby Blues (BBB) offers a 6-week therapeutic support group for women who are experiencing feelings of sadness, anxiety, isolation, or who are having difficulty adjusting to life with a new baby. Our goal is to create a safe and caring space that allows participants to connect with each other and regain their sense of wellbeing. Our support group is most often a supplemental service to individual psychotherapy and medication. We are happy to team with other providers to help our clients find individualized services that best meet their current needs.

2956 Central St, Evanston, IL, 60201, United States