Get the free Eating Disorders Referral Form

Child & Adolescent Mental Health Care Program 800 Commissioners Rd. E. TH Zone B, 8 Floor P.O. Box 5010 London, ON N6A 5W9 Telephone: 519-667-6640 CHILD & ADOLESCENT MENTAL HEALTH CARE PROGRAM EATING

How to fill out eating disorders referral form

1. To fill out an eating disorders referral form, start by carefully reading all the instructions provided. Familiarize yourself with the required information and any specific guidelines mentioned.
2. Begin by providing your personal details such as your name, age, address, and contact information. Make sure to double-check the accuracy of these details to avoid any confusion or delays in the referral process.
3. Next, you may be asked to provide information about your current healthcare provider or primary care physician. Include their name, contact information, and any relevant medical history that may be pertinent to your eating disorder.
4. The referral form may also require you to describe the specific concerns or symptoms you are experiencing related to your eating disorder. Be as detailed and honest as possible, providing information about any physical, emotional, or behavioral indicators that could be relevant.
5. You might also be asked to disclose any previous treatment or interventions you have sought for your eating disorder, including therapy, counseling, or hospitalizations. Include the names of the healthcare providers or facilities involved in your past treatment, if applicable.
6. In some cases, the referral form may require additional information about your personal circumstances, such as your living situation, family support, or any relevant financial considerations. Answer these questions to the best of your ability, providing any necessary context or details.
7. Finally, don't forget to sign and date the referral form before submitting it. This is an important step to confirm that the information provided is accurate and complete.

Who needs an eating disorders referral form:

1. Individuals who suspect they may have an eating disorder and are seeking professional help.
2. Those who have been recommended by their primary care physician or other healthcare providers to seek specialized treatment for an eating disorder.
3. Patients who are already receiving treatment for their eating disorder but require a referral to a different healthcare professional or specialized facility.

Remember, it's always advisable to consult with a healthcare professional or your primary care physician if you are unsure whether you need an eating disorders referral form. They can guide you through the process and provide the necessary assistance.

For pdfFiller’s FAQs

What is eating disorders referral form?

The eating disorders referral form is a document used to refer individuals who may be suffering from an eating disorder to appropriate healthcare providers for evaluation and treatment.

Who is required to file eating disorders referral form?

Healthcare professionals, counselors, or concerned individuals who suspect someone may have an eating disorder are required to file the referral form.

How to fill out eating disorders referral form?

The form typically requires basic information about the individual, their symptoms, and any relevant medical history. It may also include contact information for the referrer.

What is the purpose of eating disorders referral form?

The purpose of the form is to ensure that individuals with eating disorders receive the necessary care and support from healthcare professionals.

What information must be reported on eating disorders referral form?

Information such as the individual's name, age, symptoms, medical history, and contact information for both the referrer and the individual may need to be reported on the form.

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