Outpatient Eating Disorder Referral Form

Developed as a tool for outpatient dietitians who specialize in eating disorder recovery, this customizable referral form will allow you to coordinate with other therapists and dietitians whether your client is stepping down from a higher level of care or seeking treatment for the very first time.  Key assets of this document include:

• Referrer can identify primary and secondary goals of overall treatment,
• Key ED-related behaviors can be identified,
• Previous mental health, including comorbid conditions, can be noted,
• Client’s entire medical support team can be recognized,
• Trauma and substance abuse can be clearly noted, and
• Specific concerns desired to be addressed by the RDN can be indicated.

This form can be a great way to develop a cohesive plan of care with other medical support team members, especially if you are working in a private practice setting and coordinate care with multiple other healthcare providers.