About you and your services:
Degree / Credentials
Certificate and Year
Which category best describes you? *
Business Name
Business Address (Please include street, city, state, zip) *
Business Phone *
Business Email
Business Website
What is your cost per session? *
Payment options you accept *
What insurance do you accept? *
Populations you treat *
Specialization
Treatment Approach
Language fluency besides English: *
Are you available for free assessments?
Please provide a short biography about yourself, your practice, and your treatment approach for helping clients with eating disorder recovery. This will be included with your listing in ANAD's Treatment Database. *
*PLEASE NOTE: If you answer YES to any of the following 3 questions, we will follow up by phone.
Have you ever been denied membership or been disciplined by any professional society? *
Have you ever been involved in a malpractice action? *
Do you have any professional liability complaints pending? *
If you answered YES to any of the last three questions, please explain below.
Other ANAD Services:
Are you interested in assistance with starting an ANAD Support Group at your facility?
What two therapy topics could you provide expert opinions on for future ANAD blog posts and videos? (If not interested, please indicate) *
Please type your full name and today's date below as your signature, indicating that all information provided above is accurate and truthful. *
