Diabetes & Eating Disorders Group Inquiry

Name *

First Name

Last Name

Email *

Do you have a diabetes diagnosis? *

Type 2 diabetes

Type 1 diabetes

Prediabetes or metabolic syndrome

LADA

MODY

Gestational diabetes

No formal diabetes diagnosis

Other

Do you have an eating disorder diagnosis, behavior, or eating concern? *

Treatment team *

Please indicate who is currently on your treatment team. (Please note diabetes and eating disorders both require close collaboration among providers. Nutrition counseling for eating disorders without therapeutic support isn't appropriate; permission to collaborate and connect with your diabetes team and therapist will be needed before participation in the group.)

Physician/PCP

Endocrinologist or diabetes specialist

Therapist

Additional therapist or mental health specialist

Dietitian

Psychiatrist

What is your preferred format for the groups?

Exclusively virtual

Exclusively in person (Harvard Square location) -- currently not available

Mixture of in-person and virtual sessions -- currently not available

Preferred days and/or times

If there are days of the week, times of day, or specific days that would work particularly well for your schedule, please indicate below:

Please tell me a bit about what you're hoping to gain or learn by joining a recovery group. *

I invite you to share what you feel comfortable at this point about your nutrition journey and goals. Our team will also follow up with an initial phone call and assessment.

How did you hear about us? Did someone refer you?

Thank you!

A team member will reach out shortly to share more about our current openings and options. We look forward to connecting with you.

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Email Address

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