Participant Intake Form

The Sharing Group
Confidential Information

Welcome to our Application for PARTICIPANT Status for the Indra’s Net Sharing Group. We review your information and one of the facilitators leading your potential group will conduct an interview via video conference to determine your appropriateness as a Sharing Group Participant.  We ask that you affirm your adherence to the basic structure of the Sharing Group as it is attached to this form. Also please find attached the PCL-9 and the Wellbeing assessments. You will fill these out in the beginning, and again at the conclusion of your Sharing Group experience. We use these as an index of your and our impact and the success of the group.

Please fill out the following as completely as possible. It is Indra’s Net’s responsibility to carefully select Participants. All provided information is confidential and HIPAA compliant. Please be advised The Sharing Group is not a psychotherapy or medical modality.

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