HIPAA Compliant Email and DLP

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Eating Disorder Therapy LA
4929 Wilshire Boulevard, Suite 1000
Los Angeles, CA 90010
(323) 743-1122

* Name

* Email Address

* Phone Number

* State

Requested Clinician

*Client Birthdate

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

Primary Insurance

Insurance ID#

* Please let us know when you are available for appointments

Anything else we should know?