IS IT AN EATING DISORDER? Take the Quiz > (855) 875-5812

Form

Veritas Intake Form

This form includes basic demographic questions in addition to questions about you or your loved one's eating disorder and your insurance information. If you prefer, we can also complete this over the phone. Please call (855) 875-5812 to schedule an appointment if you do not wish to complete it online.

This form provides us with the basic information we need about you or your loved on to begin treatment discussions.