Start your journey with OPAL DBT Ready to get started?Want to learn more? Program Application Program Application Parent or self * First Name Last Name Email * Phone * (###) ### #### Referral Source Applicant First Name Last Name Applicant Age * 13 14 15 16 17 18 19 20 21 22 23 24 Parent/Other Grade Level * 8th Grade Attending High School Completed High School Other Applicant Phone (###) ### #### Applicant Email This is used by the applicant to access the OPAL DBT Client Portal Therapist Phone (###) ### #### Therapist Email Treatment Requested * Dialectical Parenting Group Adolescent DBT Comprehensive Treatment (individual DBT therapy and ---Multi-family DBT skills group) Adolescent Multi-family DBT Skills Group Only (retaining individual therapist not at OPAL DBT) Young Adult DBT Comprehensive Treatment (individual DBT therapy and Young Adult DBT Skills Group) Young Adult DBT Skills Group Only (retaining individual therapist not at OPAL DBT) Individual Parent therapy Individual Therapy Only Unsure What brings you here? * Thank you for your interest in treatment with OPAL DBT. We’ll do our best to respond within two business days. If not, please feel free to contact us at opal@opaldbt.com.
