This information will be used by The Anxiety/Panic Attack Resource Site to contact you if
there are any problems and/or when your group is listed.

The name of your support group:

Group Contact Information:

Contact's name or nickname:
Contact email address:

Your group's Web site: http://

Which anxiety disorders does your group support? (Please check all that apply)
Panic disorder
Agoraphobia
Generalized anxiety disorder
Social anxiety disorder
Specific phobia
Obsessive-compulsive disorder
Post-traumatic stress disorder
Friends & family members
People with any anxiety disorder are welcome

If your group is for a specific phobia, what is the phobia?

Please describe your group. (Such as, what kind of support you provide, how long you've been around, etc.)

What type of online support do you offer? (Please check all that apply)
Chat room(s)
Forum(s) or bulletin board(s)
Email list or listserv
Newsgroup
Pen pals

When does your group meet? (Days, times with time zone)

If there is anything else you'd like to explain about your group, please feel free to do so here: