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Client Reference

Client Reference
Suspect Your Client Has An Eating Disorder?

Sinnergy is Here To Help

Professional collaboration and scheduling them with an eating disorder informed dietitian, therapist or psychiatric nurse practitioner for an assessment is essential to ensure your client gets the care they need.

If you suspect your client has an eating disorder and want to refer, complete the info below or call us at 480-382-6109. We will contact your patient within one business day to learn about their condition. We will keep you updated if this client reaches out.

Fill Out the Referral Form Below

General Information

Your Name

Patient Information

Patient Name
MM slash DD slash YYYY
If patient is under 18, please provide a primary parent contact.
Parent Name

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Adolescent/ Teen Group Interest

This form is to let us know you are interested in an adolescent/ teen group. Once we have enough people we will schedule a start date and let you know.

Name

Adult Group Interest

This form is to let us know you are interested in the adult virtual group. Once we have enough people we will schedule a start date and let you know.

Name

Family/ Loved Ones Group Interest

This form is to let us know you are interested in the family/loved ones virtual group. Once we have enough people we will schedule a start date and let you know.

Name

Booking Provided by Healthie

Booking Provided by Healthie

Booking Provided by Healthie

Booking Provided by Healthie

Booking Provided by Healthie

Booking Provided by Healthie