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Houston Eating Disorders Specialists Membership Application

Thank you for your interest in becoming a member of HEDS.

INDIVIDUALS may fill out the Membership Application form below and pay via the website, or mail a check to the following address:

Houston Eating Disorders Specialists

Attn: Membership Committee
1501 Crocker Street, Houston, TX
Suite 1
Houston, TX 77019

We will contact you as soon as possible when your application is approved and your payment received. For further questions please email us at [email protected].

TREATMENT PROGRAMS: HEDS membership is open to organizations in Texas dedicated to and supportive of the HEDS mission, including eating disorder treatment programs. Please email [email protected] to request an application.

HOUSTON EATING DISORDERS SPECIALISTS MEMBERSHIP APPLICATION

First Name*
Last Name*
Credentials
Employment
Work Address*
Street Address Address Line 2 City State ZIP Code
Work Phone
Home or Cell Phone
Birth Date
Sex
- Male
- Female
Email Address
Enter Email Confirm Email
Professional Information
Highest Degree
Discipline
- Dietitian
- Psychologist
- Licensed Marital and Family Therapist (LMFT)
- Social Worker (BSW, LMSW, LCSW)
- Nurse - Please indicate specialty in the space below
- Physician - Please indicate specialty in the space below
- Other - Please indicate licensure in the space below
Please input appropriate info below.
Institutional Affiliation(s)
Professional Organizations
What year did you start working with eating disorders?*
What percentage of practice is eating disorders?
What specialized training or supervision do you have in eating disorders?
Professional References
You will need to provide two professional references for membership, including one from a member of the Houston Eating Disorders Specialists. Please provide the name, credentials, email address and phone number for your two professional references.
Name and Contact Information for Professional References
HEDS Website and Listserv
You will need to provide written permission in order to be included on the HEDS website, www.houstoneds.org, and to be added to HEDS listserv. Please indicate your preference below.
Do you want to be included in the HEDS listserv?
- Yes
- No
Do you want to be listed on the HEDS website?
- Yes
- No
Have you had any disciplinary action taken against your license(s)?
- Yes
- No
Please provide an explaination of the disciplinary action taken against you?
Membership Type and Confirmation
Please select a membership type and electronically sign the form in the space below. Upon submitting the form, you will be directed to Paypal to complete your payment. Treatment Programs: Please email [email protected] to request an application.
Product Name*
- Clinical - $50.00
- Student - $20.00
- Associate - $50.00
Please type your name below to indicate that the information you have provided is true and correct to the best of your knowledge.*

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Picking The Right Path: Guidance In Choosing The Best Level Of Care For Your Eating Disorder Patients
- Jun 2 , 2020
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Houston Eating Disorder Specialists offers our members excellent education and training, collaboration and consultation. Join our professional community today.

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Professional Networking

Join us for our bi-monthly meetings for professional networking opportunities, the latest information of patient support, and opportunities for involvement in the HEDS community by joining HEDS committees. View The Calendar

Patient Referral

Looking for an Eating Disorder Specialist in Houston? You are at the right place. Our network of specialists are here to help you cope with your eating disorder. View The Specialists

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HEDS relies on information provided by the members with regard to their credentials and years of experience.

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Houston Eating Disorders Specialists Membership Application

HOUSTON EATING DISORDERS SPECIALISTS MEMBERSHIP APPLICATION

Professional Information

Professional References

HEDS Website and Listserv

Membership Type and Confirmation

Events

Become A Member Today

Professional Networking

Patient Referral

Become a Member Today