Body Acceptance Group at Elle Studio + Wellness

Name*

First Last

Email*

Phone #*

Date of Birth*

Please check if you have one of the below insurance types. If not, please be advised that you can join us as a self pay client.*

Are you a resident of the state of Wisconsin?

Please be advised that our therapists can only see clients who reside within the state of Wisconsin.

Which Group do you prefer?

Do you currently have an outpatient therapist? If so, what is their name?

Do you currently have an outpatient dietitian? If so, what is their name?

Have you ever participated in inpatient, residential, or partial hospitalization or intensive outpatient program? If so, please provide dates.

Are you currently coping with any of the following:

Are you currently or ever been an active client of Elle for any of the below services?*

CAPTCHA

Body Acceptance Group