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Professional Referral Form

If you know a professional who treats eating issues from a faith-based foundation, please use the form below to let us know.

  • About You

  • Referral #1 (Required)

  • Referral #2 (Optional)

  • Referral #3 (Optional)


  • This field is for validation purposes and should be left unchanged.


While all contact requests are protected by the strictest confidentiality standards, for your privacy we recommend keeping your note brief and limiting confidential information until you have made a direct connection with the person you are contacting. Also, please note that some contact requests may take a few days to receive a response, depending on the schedule of the person you are contacting. If you or someone you care about are in crisis and need to talk with someone right away, please contact the NEDA hotline at (800) 931-2237 or call 911 if in the US.