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First Name
Last Name
Email
Phone
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Year of Birth
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Postcode
I need support with:
Please select...
General eating disorder information
Supporting someone
Accessing eating disorder treatment
Local referral options - GPs
Local referral options - psychologist, dietitian etc.
EDV Services - Dietetics
EDV Services - Psychology
EDV Services - Peer Mentoring Program
EDV Services - Media
EDV Services - Trainings, events and webinars
EDV Services - Telehealth Nurse
EDV Services - Wellbeing Program
EDV Services - Support Groups
I just want to talk
Other
If other:
I am contacting you as:
Please select...
Person seeking help for myself
Parent
Sibling
Partner
Other Family Member
Friend
GP
Psychologist
Dietitian
Allied Health Professional
Teacher
Other
Anonymous (would rather not disclose)
If other:
Please tick the box/es to indicate what symptoms are being experienced. This helps us better identify appropriate information and supports:
Purging behaviours
Restriction of Food
Binge Eating
Feelings of depression, guilt, shame etc
Avoidance of food types
Low weight
Eating in secret
Expressing sensory-based discomfort
Overexercising
Expressing fears of choking/ingestion
Excessive focus on healthy eating
I do not wish to disclose
You must select at least one option from this
section
Have you recieved a diagnosis?
Yes
No
What is your diagnosis?
Please select...
Anorexia Nervosa (including atypical AN)
Bulimia Nervosa
Binge Eating Disorder
ARFID
Pica
Rumination Disorder
OSFED
OSFED - please expand on your diagnosis:
Please explain why you are contacting us today. We appreciate if you can be as detailed as possible so that we are able to provide you with the right information in a timely manner. If your enquiry is regarding someone who may have an eating disorder, please ensure you include their age.
How did you hear about the EDV Hub?
Google
GP/other health professional
Social media
Family/friend/colleague
Other
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