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Formulario de admisión

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Debido a las leyes de licencias del estado de Nueva York, solo podemos registrar a residentes del estado de Nueva York para telesalud y grupos de apoyo.
Nombre*
Correo electrónico*
Dirección*
Nota: Todos los grupos presenciales y virtuales están limitados a aquellos en el área de la ciudad de Nueva York/Long Island. Comuníquese con nosotros ya que podríamos brindarle recomendaciones de organizaciones fuera de nuestra área.
Nombre del ser querido*
Select date MM slash DD slash YYYY
Select date MM slash DD slash YYYY
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Grupo de duelo en persona para familiares de habla hispana. Si no ofrecemos el tipo de grupo que busca, haremos todo lo posible para recomendarle otra organización.
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Para mantener números de grupo que permitan a los participantes tener la mejor oportunidad de conectarse y compartir, no podemos garantizar espacio disponible en cada grupo en todo momento, pero trabajaremos con usted para encontrar la mejor opción para sus necesidades.
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Días de grupos de duelo: ¿Hay alguna noche en la que NO esté disponible? (Marque todo lo que corresponda)...
¿Dónde ha encontrado apoyo desde su pérdida? (Marque todo lo que corresponda)
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