Body Image Support Group

We will be running a new Phase 2 Body Image Support Group spinning off from our original group starting  Monday, February 3rd every two weeks from 4-5pm bi-weekly for 6 weeks virtually.  This group is intended for any and all individuals struggling with body image concerns as a result of systemic and sociocultural factors including but not limited to diet culture. This group will be led by Advanced Placement Social Worker, Lexi Mulkusak, and Licensed Professional Counselor & Clinical Supervisor, Sarah Adler. Both Sarah and Lexi specialize in providing eating disorder,  anxiety-based, and some trauma treatments for adult clients. 

Members will be expected to have already completed the Body Image Support Group: Part 1, or receive approval from the group leaders if feeling that you have already acquired and feel confident in their efforts to utilize knowledge on diet culture, Intuitive Eating (IE), and Health At Every Size (HAES). Therapist referral may be required.

This group is structured utilizing the books "The Inside Scoop on Eating Disorder Recovery" by Colleen Reichmann, PsyD and Jennifer Rollin, LCSW-C and "Body Kindness" by Rebecca Scritchfield, RDN, co-facilitators will assist members in continuing to navigate the process of healing their relationships with food and their bodies. This will include practical tips and strategies, but also include peer-led support and space to process the experience of living within diet culture.  Members are encouraged but not required to have a copy of the book. Co-facilitators will provide handouts to those who do not have access to the book.  The group provides practical skills to use in your everyday life, supplemental materials, peer support, etc.

Cost: $75/session.  This cost is not necessarily your out of pocket expenses after processed with insurance. There is a $75 deposit to attend the group that is fully refundable with completion of the group or with drop out prior to the 2nd session. Insurances accepted: Dean, Quartz, GHC, Optum/United Healthcare, Evernorth, Cigna, Health Partners of MN, The Alliance, SHIP, UMR, Aetna, Multiplan, PHCS, Health EOS. If you do not have any of these insurances, you would be responsible for paying out-of-pocket. Please verify with your insurance that you have coverage to attend groups using the billing code 90853.

Please complete the information below to get signed up. Please make sure all fields are completed to allow us to verify your payment information/insurance prior to the group. Call our office if you have any questions. 


Thank you!

Sign in to Google to save your progress. Learn more
Email *
Full Name *
Telephone #  *
Date of birth *
MM
/
DD
/
YYYY
Email *
Are you a current Synergos Counseling client? *
Have you attended the Body Image Support Group: Part 1 in the past? *
If you are not a Synergos Counseling client, do you want to privately pay (credit card) or use insurance? *
If using insurance, what insurance do you have? *
Please verify that you understand there is a $75 deposit required that is refundable at the end of the group or with drop out prior to the 2nd session, otherwise it would be considered non-refundable.  *
Required
Please verify that you understand our cancellation policy which requires notice in writing or a voice message to our office 24 hours before each Tuesday group that you are unable to attend to avoid financial penalty. Additionally, if you do not provide any notice and miss a group you will be charged the full cost of the group. The missed or late cancel penalty will be charged to your card on file. Thank you! *
Required
Who referred you to this group? *
Additional Information
You will receive a call from our staff within 48 business hours. If you do not, please call our office at 608-405-5111 or email contactus@synergoscounseling.com to verify you have been added to the group attendance list. There is a $75 deposit to attend the group that is fully refundable with completion of the group or with drop out prior to the 2nd session, otherwise it would be considered non-refundable. **We ask that you miss no more than two sessions to ensure the creation of a safe, conducive culture among group members. If you decide the group is not the right fit for you, please let us know by Friday at noon prior to the third group to prevent any financial penalty.   Thank you!
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
This form was created inside of Synergos Counseling.

Does this form look suspicious? Report