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Circle of Release
Group Face to Face in Porepunkah
Sunday 5/4/2026 at 3pm
1 Martley Street, Porepunkah
First name
*
Last name
*
Email
*
Name your loss
*
Are you able to identify the emotions you are feeling about the event?
*
Yes
No
If yes, can you identify the strength of the feeling, 1 being very weak to 10 being very strong
*
1
2
3
4
5
6
7
8
9
10
Do you believe in a power greater than yourself?
*
Have you experienced therapy before?
*
Yes
No
Thank you. We have received your information for Circle of Release Group Session, Face to Face at Porepunkah Community Hall. Sunday 5/4/2026 at 3pm 1 Martley Street, Porepunkah
$95
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