Comprehensive Behavioral Health Services
Psychology &
Counseling
Associates, P.C.
Mark A. Greenberg, Ph.D.
Jane R. Greenberg, Ph.D.
Directors
Jeffrey M. Walters, Psy.D.
Clinical Director
Please register me for:
Class Date:
Name(s)
Relationship
Status
Address
City, State, Zip
Home Phone
Work Phone
Cell Phone
eMail
Wedding
Date
if applicable
How did you hear about this program?
50% of the fee is required at least one
week prior to the group/workshop.  The
balance may be paid on the first day of the
group/workshop. Checks should be made
payable to PCA.  Visa and MasterCard are
accepted.
Return payments to:
Payment Terms:
Attn:  Groups
2091 East High Street
Pottstown, PA 19464
with Visa or MasterCard on our
secure server.