Health Psychology Center Women's Weight Research Program

Weight group participation form

How did you hear about our program?

   

Please provide your current height and weight. This information is needed to determine study eligibility

Refer to this BMI chart to confirm that you meet the program criteria of a BMI of 25 or above.

I am submitting my name and information for participation in the weight group program.

  • I understand that if I am assigned to the in-person group, I must commit to weekly meetings which will be held for 8 weeks, beginning February 17, on Monday evenings from 5:00 to 6:30 pm.
  • I understand I must submit the provided physician's release form before the program begins. (Form found on previous program detail page.)
  • I do not have an eating disorder, either currently or within the past year, such as anorexia (starving) or bulimia (purging).
  • I do not suffer from untreated depression (moderate to severe).
  • I am able to walk without restrictions.