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Menopause Wellness Group – Participant Registration Form

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Menopause Wellness Group – Participant Registration Form

Have questions? Need more information? Contact us! (613) 549-7850 Or fill in the form below and we'll call you!

Disclaimer*
I acknowledge this disclaimer.
**All information collected is private and confidential, but if uncomfortable completing the information on-line, please contact Intake directly at 613 549-1180.
We invite you to join our Menopause Wellness Group, a supportive and confidential space designed for individuals navigating perimenopause and menopause. This group will provide education, shared reflection, and practical tools to support emotional, physical, and mental well-being during this stage of life. Together, we will explore topics such as hormonal changes, stress, sleep, mood, self-compassion, and strategies for feeling more grounded and empowered.

Contact Us
Have questions? Need more information? Contact us!
(613) 549-7850
Or fill in the form below and we’ll call you!
Full Name*
Date of Birth
MM slash DD slash YYYY
Email Address*
Phone Number*
Hidden
Date and Time of Submission
Group Experience & Goals
Group Experience & Goals Can you briefly describe any menopause or perimenopause symptoms you are currently experiencing? (Optional – shared to help facilitators tailor the group):
Accessibility & Comfort
Is there anything specific you are hoping to gain from this group? Are there topics you would especially like us to cover?
Accessibility & Comfort
Do you have any allergies, dietary needs, or sensitivities we should be aware of? (Snacks and drinks will be offered.)
Do you have any accessibility requirements?
Do you have any accessibility requirements?
Please indicate your preferred method of payment:
Payment Method*
Address*
Street Address City State / Province / Region ZIP / Postal Code
Please note:
Spots are limited to 12 participants. Registering early with your initial payment of $130 to help to secure your spot. Unfortunately we cannot guarantee a spot until payment is received. Receipts will be provided at the end of each session. This group is covered under most benefit plans but please check with your benefit provider to confirm. Thank you.

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We’ll be happy to answer all of your questions and make sure you have an amazing experience.

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At Resolve Counselling Services, we understand what it’s like to face life adversities without the appropriate support. That’s why we’re offering a variety of counselling services. So you can overcome challenges and improve your social, emotional, and economic well-being.