For appointments/inquiries: (214) 755-6119

Therapy Dallas specializes in individual and family-based treatment for children, adolescents, and adults.

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Inquire/Register: SPACE Parent Group

Interested in joining this group? Please complete the below questionnaire.
Upon receipt, we’ll reach out to answer questions and discuss next steps.

Child's Full Name

Age

School

Parent/Guardian's Full Name

State of Residence

Parent Phone

Parent E-mail

Preferred contact:

Phone E-mail

Please provide some basic information about your household (e.g., marital status; whether parent(s) work inside or outside the home; siblings/ages; whether child spends time in one vs. two households; etc.):

My child struggles with:

Anxiety OCD

These concerns are:

Formally diagnosed Suspected

My child tends to struggle with:

Separation from parents/caregivers Sleep/bedtime concerns Social situations/demands Performance and/or perfectionism Germs/cleanliness Rigidity/compulsivity Other concerns

Please rate the severity of these concerns:

Mild Moderate Severe Unknown

In attempts to reduce my child's anxiety, I/we tend to:

Do things I wouldn't otherwise do NOT do things I would normally do Reduce or eliminate certain demands Adhere to specific/rigid rituals or routines Answer questions repeatedly Other None of the above

Please list any additional suspected or diagnosed mental health concerns (e.g, Depression; ADHD; Learning Differences, etc.):

Please describe any/all mental health services you've sought in hopes of reducing your child's anxiety and/or OCD (e.g., individual therapy; medication; parent consultation, etc.):

How effective have you found these interventions? (enter "N/A" if you've not sought prior treatment)

If your child is currently in individual therapy, are you comfortable sharing with your child's provider the fact that you may participate in this parent group?

Yes No Not applicable

What would you hope to get out of this group?

Do you have a preference for how we meet?

In-person Virtually I'm flexible

Please enter below any additional information you'd like to share and/or questions you have at this time:

How did you learn of this group?

Contact Us

Therapy Dallas
12800 Hillcrest Rd A124, Dallas, TX 75230
214-755-6119 (office) • 214-481-2851 (fax)

Want to learn more?

Our therapists enjoy presenting on topics
related to child/adolescent development
and mental health, and welcome interested
parents, caregivers, educators, and/or
professionals to attend upcoming presentations.

Click the Share tab for upcoming events!

Join our Presentations Mailing List

Want to be notified of upcoming presentations
and resources available through our practice?
Click here to sign up for e-mail notifications
of your choosing.

Inquire/Register: SPACE Parent Group

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