This is a survey to assess interest in a *virtual* support group for adult adopted/former foster individuals who have experienced or are experiencing disordered eating. You do NOT have to be diagnosed with an eating disorder to participate. Disordered eating behaviors do not necessarily equal a clinically diagnosable eating disorder, but it can make your life a pain! People anywhere in the U.S. would be welcome. In this survey you will have a chance to say what days and times might work for you, as well as frequency of meetings. With adequate interest, the group will begin meeting in the Fall, 2023. Cost will be $65 per session. Group will be facilitated by Katy Perkins Coveney, Licensed Clinical Social Worker, a reunited adopted person and therapist who specializes in post adoption with adult adopted people, childhood/adult trauma, eating disorders, domestic/sexual violence, DNA discoveries, oppression, and identity distress.

Your feedback will help us prepare to have the best group experiences possible. We will send you information about the group once we have enough interested participants (at least 3). If we have a large amount of interest, we may add a group facilitated by another licensed clinician from FindSelf Counseling.

Once you finish the survey, we will send you an email within about a month to follow up and keep you posted on the screening process.

Thank you!

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* 1. I am interested in participating in this group (Don't worry, you're not committing to it right now, just expressing interest.)

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* 2. Please enter your contact information below

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* 3. Have you ever participated in a support group before? If so, what topic?

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* 4. **GROUP FREQUENCY**    I would prefer meeting:

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* 5. **DAYS & TIMES**   I would prefer the group meet:

  NO, THANKS. I CAN MAKE IT WORK, IF NEED BE. THAT'S PERFECT!
TUESDAY 8AM-9:15AM EST
TUESDAY 11:45AM-1PM EST
WEDNESDAY 8AM-9:15AM EST
WEDNESDAY 11:45AM-1PM EST
THURSDAY 9AM-9:15AM EST
THURSDAY 11:45AM-1PM EST
THURSDAY 5:30PM-6:45PM EST
SATURDAY 9AM-10:15AM EST
SATURDAY 10AM-11:15AM EST
SATURDAY 11AM-12:15PM EST

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* 6. I understand that if I am not already a client of FindSelf Counseling, I will have to go through a screening process to determine whether the group is appropriate for me; and that expressing interest in the group does not guarantee that I will be admitted to participate.

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* 7. Please add me to your email list for additional practice information such as groups, therapy, professional and personal training, speaking events, etc.

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