Get the free Eating Disorders Intake Referral Form

Last updated March 2024Windsor Essex Eating Disorders Centralized Intake Referral Form (Fax completed referral forms to INTAKE at (519) 9690227) Incomplete or illegible forms will be returned for

How to fill out eating disorders intake referral

How to fill out eating disorders intake referral

1. Obtain the intake referral form from the eating disorders treatment facility.
2. Fill out personal information such as name, address, contact details, and insurance information.
3. Provide medical history including past diagnoses, treatments, and current medications.
4. Describe the current eating disorder symptoms, behaviors, and concerns.
5. Include any relevant information about previous therapy or counseling experiences.
6. Note any specific mental health or medical professionals involved in the individual's care.
7. Sign and date the intake referral form and submit it to the treatment facility.

Who needs eating disorders intake referral?

1. Individuals who are seeking treatment for an eating disorder.
2. People who have been referred by their primary care physician, therapist, or other healthcare provider.
3. Family members or loved ones of someone with an eating disorder who is looking for help on their behalf.

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What is eating disorders intake referral?

Eating disorders intake referral is a form required to be completed when referring an individual to a treatment program for eating disorders.

Who is required to file eating disorders intake referral?

Healthcare professionals, social workers, or other individuals involved in the care of the individual with an eating disorder are required to file the intake referral.

How to fill out eating disorders intake referral?

The intake referral should be filled out with the individual's personal information, medical history, and reason for referral to the treatment program.

What is the purpose of eating disorders intake referral?

The purpose of the intake referral is to ensure that individuals with eating disorders receive the appropriate care and treatment needed.

What information must be reported on eating disorders intake referral?

Information such as the individual's name, contact information, medical history, insurance information, and reason for referral must be reported on the intake referral.