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1295 Bandana Boulevard West
Suite 310 & 210
St. Paul, MN 55108
P: 651-645-5323
F: 651-621-8490
Toll-Free: 1-888-364-5977

Nurse talking to patient


Healthcare Provider History

Who have you worked toward recovery with so far? This gives us a comprehensive view of your current and former providers. Please list any providers that you or your loved one has seen in the past year.

This form tells us what medical or clinical treatment you or your loved one may have received in the past six months, whether for an eating disorder or other conditions.