How did you hear about us?
If no, please specify how you would prefer for us to communicate with you?* (e.g telephone, email, Whatsapp text, Whatsapp video, text message etc.)
Are you happy to speak to our practitioner via Zoom so that she can learn a bit more about you and answer any questions you have? (Yes / No)*
Our core six-month programme is a five-figure investment. Are you ready to invest in your recovery?*
Are you ready to start your programme with us today? (Yes/No)*
What makes you most excited about this process?*
Are you currently receiving treatment for an eating disorder? If so please specify.*
Which of the following do you feel are important to your recovery?* (e.g. Relationship with food, relationship with body, nutrition support)
Is there anything you would like to share about your journey so far?*
Please tell us a little about what you would like to achieve through your programme.*
Email Address*
Phone Number*
Age*
Full Name*
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