Find A Specialist Application

Full Name

Title

Organization

Street Address

City

State/Province

Zip/Postal Code

Work Phone

Fax Number

Home Phone

E-mail

(Please list the email you would like to be used on our Google group)

Website

Please provide details about your education, including institutions and degrees you receieved:

Undergraduate

Graduate

Additional Education

Years of direct clinical experience treating EDs. (Must have at minimum 3 years direct clinical experience)

List all employment history

Year joined CTEDS (must be a CTEDS member for at least 1 year and have attended a minimum of 5 CEU events)

Upload 5 CEU Certificates from CTEDS events

I consent to the use of my email by CTEDS for the listserv and marketing education events.

Consent

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