Group Inquiry Form Please fill out the form below if you are interested in joining one of our groups. A member of the FCT team will contact you regarding the intake process. If you have any questions about the form and require assistance, you can contact us at 617-332-5777. Please note that FCT's clinicians are only licensed to provide support for individuals who live in Massachusetts. Name* First Last Phone*Email* Address*Please note that FCT only provides support to individuals who live within the state of Massachusetts. Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Date of Birth* MM DD YYYY Gender*PronounsRace*This information is used for funding applications. American Indian or Alaska Native Asian Black or African American Native Hawaiian or other Pacific Islander White Are you Hispanic or Latino?*This information is used for funding applications.YesNoContact preference*Please let us know the best way to reach you.EmailPhoneTextHow did you hear about FCT?*Are you familiar with Zoom?*YesNoGroups*Please indicate which of the following groups you are interested in joining. Cancer Support Group Caregiver Support Group Adult Bereavement Group Young Adult Bereavement Group Multiple Myeloma Networking Group Chinese Brush Painting Writing for Wellness Additional InformationPlease feel free to let us know if you have any questions or other information you would like to share with us.
