Chronic Illness & New Diagnosis Support Group Registration

Patient first and last name

Patient date of birth

Email

Primary phone number

Relation to patient

Caregiver first, last name and email

Which 6-week session are your registering for?

What are you hoping to gain from this group?

Please sign below acknowledging the group rules:

This support group is for National Jewish Health patients (and caregivers) who have been recently diagnosed or currently living with a chronic illness.

We ask while attending the group you consider the following ground rules:
This is a mutual self-help group, not a therapy group. Hopefully, this group will provide emotional, psychological, and moral support for its members. Each of us is encouraged to participate to whatever extent we feel comfortable. The following ground rules facilitate the development of trust in the group and enable us to share our thoughts and feelings with each other.

1. Because confidentiality is essential, we expect that each person will respect and maintain the confidentiality of the group. What is said in the group is not to be repeated or discussed at any other time or place.
2. We are here to share our own feelings and experiences; we try not to give advice.
3. We each share the responsibility for making this group work.
4. We try to accept people, just as they are, and we avoid making judgments.
5. We try to give everyone an opportunity to share.
6. We have the right to speak and the right to remain silent
7. We avoid interrupting. If we do break in, we return the conversation to the person who was speaking.
8. We have the right to ask questions and the right to refuse to answer.