Encrypted Contact Form

Eating Disorder Therapy LA
4929 Wilshire Boulevard, Suite 245
Los Angeles, CA 90010
(323) 743-1122

* Name

* Email Address

* Phone Number

Requested Clinician

* Insurance Type

Anthem Blue Cross of California Aetna Anthem Medi-Cal Use My Out of Network Benefit Pay Out of Pocket

Insurance ID#

*Client Birthdate

* Please let us know briefly what you are seeking counseling for

* Please let us know when you are available for appointments

Anything else we should know?

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