Membership Information

My Referral Listing (Name EXACTLY as you want it to appear on OEDA's website and in print)
Professional Credentials
Certifications
Website URL, or email you wish to be linked on our website
Treatment Specialties
Business/Organization Name
Primary Practice Address
Practice Phone Number
Treatment Setting
  • Inpatient
  • Residential
  • Outpatient
  • School/College Counseling
  • IOP
  • Other
Treatment Modalities
  • Individual
  • Couples
  • Group
  • Family
  • Medical
  • Nutritional
  • Other
Populations Served
  • Anorexia
  • Binge Eating Disorder, Compulsive Overeating
  • Bulimia
  • Disordered Eating
  • Obesity
  • Body Dysmorphic Disorder
  • Obsessive Compulsive Disorder
  • Laxative Abuse
  • Bariatric Surgery Assistance
  • Compulsive Exercise
  • Males
  • Children
  • Adolescents
  • Infants
  • Adults
  • Athletes
  • Other
Practice Description
Other Memberships
Do you know any professionals who would like to be contacted about OEDA's professional network?

Personal Contact Information

Country*
State / Province*
Address*
City*
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Email*
Confirm Email*
Phone*

Payment Information

Amount*
$
Name on Card*
Card Number*
Additional Comments

Security Code