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Yap! Intake Form

Let's start with your personal details

Emergency contact

What brings you to yap? (Share what you're hoping to find or explore here.)

Are there specific topics or issues you'd like to discuss?(E.g., substances, gender, sexuality, loneliness, healing, community.)

*

Have you participated in other support or community groups before?

If yes, please describe:


Have you participated in other support or community groups before? If yes, please describe:

What do you most need from this space? (E.g., connection, validation, understanding, space to share, etc.)

How have you been feeling mentally and emotionally lately? (You can be general—e.g. are you in crisis, feeling okay, stressed, overwhelmed.) 

Are you currently experiencing any physical and/or mental health challenges that we should be mindful of?

Confidentiality & Anonymity

Confidentiality & Respect Agreement: 

I understand that what is shared within this group is private and confidential. I agree to respect the privacy of others by not sharing their stories or personal information outside of this space. I commit to creating an environment of trust, openness, and compassion, and to maintaining the confidentiality of all participants. 

Do you agree to uphold this confidentiality and respect others’ privacy?


Confidentiality & Anonymity
Thank you for sharing. Your honesty helps us create a safe, supportive environment where we can all grow and connect. We look forward to walking this journey together. :)