Name *

First Name

Last Name

Phone

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What would you like to work on in treatment?

Disordered eating

Body image concerns

Anorexia nervosa

Bulimia nervosa

Binge eating disorder

Mood/depression

Anxiety

OCD

Trauma

Substance misuse

Personality disorder (e.g., BPD, NPD)

Relationship/Family issues

Maladaptive coping

Self-harm

Group Therapy