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Support Group Leader/Co-Leader Application
As a Barix Clinics' Support Group Leader, you can plan an important role in helping people achieve their goals to lose weight and keep it off.  The information, peer support and relationships that the support group provide are a key part of the program.  The Leader's role requires a significant committment of time and energy, but the positive impact on others can be even more significant.  The application procss will give you insights to the responsibilities and rewards in a leadership position with a Barix Clinics' Support Group. 

First Name
 * required
Last Name
 * required
Mailing Address
 * required
 * required
 * required
Zip Code
 * required
 * required
Email Address
 * required
Emergency Contact (Name and Phone Number)
I agree to support the Barix Guidelines:
Limiting added sugars to 2 grams/serving.
Limiting fat intake.
Regular exercise.
Vitamin supplementation guidelines.
Attending follow-up appointments.

I have reviewed the positon description and agreement and am able to fulfill the responsibilities as outlined:


I have adequate time to commit to this position:

Do you currently or have you in the past attended a Barix Support Group?
List leadership positions that you have held:
List ideas that you would like to bring to your support group:
How has bariatric surgery changed your life:
Do you personally follow Barix recommendations?
Are you at a healthy weight?


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