Austin ED Recovery Empowerment Group
Please fill out so I can show up ready to serve you at group!
Name *
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Email *
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Address *
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Phone number *
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Emergency Contact Name & Number *
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Gender? *
What type of eating disorder are you struggling with? (select all that apply.) *
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What age did your eating disorder begin? *
Your answer
How old are you now? *
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Are you under the care of a doctor? *
Please select all treatment options you are currently receiving. *
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What is your #1 challenge around recovery right now? *
Your answer
What other information should I know?
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