Client Application

for Treatment Assistance

  • Scholarship Applicant

    Please enter information about the applicant.
  • Healthcare Provider

    Please enter information about your Healthcare Provider.
  • Treatment Fund Amount: $1000.00

     

    Each treatment fund is for $1000.00. In order for the application to be approved, practitioners must agree to a sliding scale of $100 for ten 45-60min sessions or 20 groups at $50.00 per group. The practitioners must fill out their own application, also available on our website. Both client and practitioner forms must be received in order for application to be processed. Note, this scholarship can be used to combine group and individual treatment as well as split between providers. If it is split, both providers will need to fill out a provider portion of the application.

     
  • Please enter a number less than or equal to 10.
  • Please enter a number less than or equal to 20.
  • Drop files here or
  • Applicants must have a diagnosis of an eating disorder, or be seeking assessment for one. The EDRS Treatment Fund Committee will provide funds upon approval, to the Provider. The Provider is responsible for reporting back to EDRS that the funds were used, or portions were used/unused, and the progress of the treatment fund recipient. Any unused funds are agreed to be returned to the EDRS treatment fund. Applications may be submitted online or mailed to the following address:

    EDRS TREATMENT FUND

    Attention: Treatment Fund Committee
    911 Lakeville Street, Suite 217
    Petaluma, CA 94952
    EDRS Phone: 833-LUV-EDRS (833-588-3377)

  • By entering your Full Name below, you confirm that the above information is true and correct to the best of your knowledge.
  • Date Format: MM slash DD slash YYYY

Our Mission

The mission of EDRS, Inc. is to promote recovery and wellness for those impacted by eating disorders by providing support, information, and education to individuals, families, professionals, and the community at large regarding eating disorder recovery and resources..

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Contact Us

Eating Disorder Recovery Support

c/o Liz Woodruff, PhD
911 Lakeville Street, Suite 217
Petaluma, CA 94952

+1 (855) LUV-EDRS (855-588-3377)

info@edrecoverysupport.com