Register your interest in getting support from our services
Before you start
It's great that you've taken the first step of searching for help. While we don't currently have something to offer you, we would like to take your details for future interest.
Please be advised that we will not be able to reply to the completion of this form, but we will retain your information and contact you should funding become available in your area in the near future.
By filling in this form, you give consent for your data to be used in line with our
privacy statement
Type of support
Please let us know which of the following applies to you:
I am supporting someone else who has an eating disorder
I am experiencing an eating disorder
Which Eating disorder do you most identify with experiencing?
Please select...
ARFID (Avoidant Restrictive Food Intake Disorder)
Anorexia Nervosa
Binge Eating Disorder
Bulimia Nervosa
OSFED (Other Specified Feeding and Eating Disorder)
Other
Which Eating disorder does the person you support most identify with experiencing?
Please select...
ARFID (Avoidant Restrictive Food Intake Disorder)
Anorexia Nervosa
Binge Eating Disorder
Bulimia Nervosa
OSFED (Other Specified Feeding or Eating Disorder)
Other
Your First Name
Your Last Name
Your Email Address
Your Date of Birth (format: dd
/
mm
/
yyyy)
Postcode
Contact Information