PEER MENTORING PROGRAM PARTICIPANT REGISTRATION

Please note all your information is kept private and confidential.

Thank you for applying for the Peer Mentoring Program. 

Please answer all questions below truthfully and accurately, if you have any questions feel free to contact Rachael Duck on (03) 9994 0354 ext 214 or send her an email with subject Peer Mentoring Program at Rachael.duck@eatingdisorders.org.au. 

Please have the following information with you before starting this registration form:
  • The contact details (including phone and email) for your GP, mental health clinician and personal support person
  • Your expected availability to meet with your mentor during the program. Please note that mentoring can only take place between Monday - Saturday (between 8.00am and 8.00pm) and only a maximum of 6 of your 13 mentoring sessions can take place on a Saturday.
Keep in mind that:
  • All fields marked with an asterisk (*) on the application are required.
  • You must click the 'Submit' button at the end to send your application to our PMP team for consideration.
At this time, you have to finish the application in one sitting. If you leave the form idle for more than 20 minutes, your session will expire, and you will have to start over!

Here at EDV, we are always trying to make things easier for our community, this form is new and we are still working out some tech things! If you are having troubles submitting this form, please contact Andrew on andrew.synnot@eatingdisorders.org.au or 9994 0354 ext 227 and he can help you out (please note Andrew works Tuesday-Friday).











Please make sure to only use numbers (no spaces or special characters)!
Please note: once you have submitted this form, a confirmation email will be sent to the client only. You can contact Rachael from EDV on
(03) 9994 0354 ext 214 or send her an email with subject Peer Mentoring Program at Rachael.duck@eatingdisorders.org.au.

The rest of the information relates to the client you are referring.




Please make sure to only use numbers (no spaces or special characters)!
























Please answer the below in numerical form.
How long have you had the eating disorder for?





















Support Action Plan

Ongoing and regular engagement in treatment is a condition of participation in the program.

Please note that engagement in PMP requires you to provide 3 support contacts and consent for EDV to share and receive information about you with these nominated people. These support contacts will be informed of your involvement in the program and will be contacted should risk be identified.

If these supports change, the participants must update EDV as soon as possible.






Please make sure to only use numbers (no spaces or special characters)!













Please make sure to only use numbers (no spaces or special characters)!













Please make sure to only use numbers (no spaces or special characters)!







Matching Information: Tell us a little bit about you
Details provided in this section will help to guide the matching process along with other organisational considerations.
















Here at EDV, we are always trying to make things easier for our community, this form is new and we are still working out some tech things! If you are having troubles submitting this form, please contact Andrew on andrew.synnot@eatingdisorders.org.au or 9994 0354 ext 227 and he can help you out (please note Andrew works Tuesday-Friday).