A woman places her hand on the shoulder of another woman in a support group setting.

Support Group Interest Form

If you are interested in participating in one of our support groups, please complete the interest form below. A staff member from Alexandra House will contact you within three business days to explain the groups and register you. Our services are confidential, free, and accessible on any device.

If you are seeking help, we highly encourage you to call our 24-hour helpline. We are not able to respond immediately to advocacy requests submitted here. 

Support Group Interest Form

Name(Required)
Birth Date(Required)
Is it safe for us to email you?(Required)
Is it safe for us to call or text you?(Required)
Is it safe for you if we identify ourselves as Alexandra House when contacting you?(Required)
Address
Have you attended a support group in the past?(Required)
If your desired support group is full, would you like to be put on a waiting list?(Required)
Date submitting form: