Support Group Signup
I understand and agree to the following conditions for participating in an educational support group hosted by Mirasol:
- I understand the the support group facilitator provides neither individual nor group psychotherapy, and I and acknowledge that no client/therapist relationship is formed by my participation.
- I understand that the group does not provide any psychological, medical, psychiatric services or 24-hour Crisis Care.
- I agree that if it is determined that my participation in the group is no longer appropriate, I may be asked to leave. If at any time, I appear to pose a danger to myself or other members of the group, the facilitator will contact the appropriate legal agencies and/or representatives.
- I understand that I may be required to be have ongoing care from a psychological or psychiatric licensed professional in order to participate in the support group.
- I promise to respect the privacy of group members and keep information about them in strictest confidence at all times.
- I expressly assume all risks associated with participation in the support group.
- I hereby releases Mirasol, Inc., and any employee, officer, director or other person associated with Mirasol, Inc., from any and all liability or harm from participation in the Mirasol Eating Disorder Support Group.
Participant
To provide the best possible experience for all participants, we are limiting attendance to 10 people first-come, first-served. If the group is full, you will be added to the wait list.
