Contact Us

Schedule An Appointment

To request a consultation/appointment, please complete the form below or call our office. After submitting your request we will work diligently to provide a quick response. Please be aware we do not take Badgercare/Medicaid/Forward Health at this time. If your insurance is out of network, we are able to provide you with a "superbill" to submit directly to your insurance for reimbursement to you directly after privately paying for your services with us.

Please ALWAYS verify that your health plan includes dietary benefits. Some plans have many exclusions to what would be included as well. She can provide you a "superbill" to submit to your insurance for out of pocket expenses.

We are offering HIPAA compliant telehealth services as well as some limited in-person options. If using telehealth, please check with your insurance to assure you have telehealth benefits.

Additionally, we require that you have access to both video and audio features in a secure location when participating in telehealth as this is most often required by your insurance for reimbursement. We are unable to do sessions while you are in your vehicle traveling as well.

Masks Optional in-person. Your provider is also comfortable wearing a mask if you request it.

We have immediate openings with Katy, April or Ashley for counseling & Christy or Karin for Registered Dietitian support. Please complete the inquiry below or call our office. Thank you!

If you have concerns related to body image, disordered eating, nutrition, and related concerns. please follow this link to complete an additional form to help us find staff that best fits your needs. Thank you!

* Indicates required field

Name *

First

Last

If you are not the potential client please indicate who is in addition to their age. *

Preferred Pronouns (she/her, they/them, he/him) *

Phone *

Email *

Clients date of birth *

What service (s) are you interested in? *

Do you have a history of an eating disorder, disordered eating (frequent dieting, hiding food, binge eating, food restriction), or body image concerns (frequent weighing, excessive worry about weight or fear of weight gain)? If no, please select "no" in the box below. If yes, please follow the link above this form to complete an additional form to help us find staff that best fits your needs. *

No Yes and I completed the form through the link about this inquiry.

Reason for visit *

Availability for Sessions *

Are you the primary policy holder for your health plan? *

Form of Payment *

If a provider was not in-network with your insurance/health plan, would you be interested in privately paying for services? *

We typically have a waitlist, would you like to be added to it if there is not immediate availability? *

Yes No

How did you hear about us? *

By completing and sending this form, you consent that you understand that this form is not HIPAA compliant. For increased privacy and security, please call our office at 608-405-5111. *

I agree to receiving marketing and promotional materials

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Client Portal Client Portal- Existing Clients

If you are interested in a complimentary yoga session in our wellness center, please create a profile at www.momoyoga.com/synergos and we will add that to your account for all new students.