Web Submission Terms

The information you submit on our “Get Help” forms will be used internally for the purposes of processing and responding to your request. It may be routed internally in order to find the most appropriate member of staff to handle your request and your contact information will only be used to respond to your inquiry if you indicate permission to do so. The information submitted may become a part of your electronic health record at The Emily Program, should you choose to proceed with utilization of The Emily Program’s services, and this information may be used in the planning of treatment and care provided to you. By providing your phone number and checking the box on the form, you also consent to receive text messages from us. Standard text message and data rates may apply. You may reply STOP to opt out, and HELP for help. These messages may include information about treatment at The Emily Program, general facts about eating disorders, and other relevant healthcare communications.

Texting, phone calls, and emailing are not intended to be used for therapy or other medical and mental health treatment. If you are experiencing a medical emergency or are in crisis, please call 911 or go to your nearest emergency room.

At all times, The Emily Program’s Notice of Privacy Practices will apply to the information submitted on this form and to any other personal and protected health information that The Emily Program maintains. While we take steps to limit the amount of information communicated electronically to you, there are risks associated with transmitting information this way. By submitting your contact information on this form, you expressly agree to our Notice of Privacy Practices policy, which outlines how we use your information, how we maintain security of your information, and how you may opt out of receiving communications.