ED Contact Info

1

Which Eating Disorders Group are you interested in?* This field is required.

Wednesdays starting November 9th 2022: 2:00-3:30pm EST - 13 Weeks

Not sure, want to discuss with Layla

2

Do you feel comfortable being in a group of up to 10 participants?* This field is required.This is an online video group, but you can choose to only display your first name in the group. Everyone will be asked to commit to confidentiality

Yes

No

Maybe. Want to talk to Layla/the therapist first

3

Program available to residents of Ontario, Alberta, and British Columbia, 18 years or older* This field is required. At this time, the program is open to residents of Ontario, Alberta, and British Columbia.

4

Name* This field is required.

First Name

Last Name

5

Email* This field is required.

example@example.com

Confirm Email

6

Privacy of your information* This field is required.Layla respects your right to privacy. Please read our policy to understand how we collect and use personal information

7

Groups

ED Skills Group

8

Intake Form Complete - For Salesforce Integration

Interest Form Complete

9

Layla is not a crisis service* This field is required.If you or someone you know is in crisis or at risk of serious harm towards yourself or others, call 911 or go to an emergency room