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Modal Buttons: Appointment Requestmeredith@swiftlycreative.com2022-02-03T23:37:46+00:00

Before requesting an appointment, please select whether you are a new patient or an existing patient.

Existing Patient

5202 Bethel Reed Park, Suite 200
Columbus, OH 43220

tel: 614.431.1418
fax: 614.678.5556
info@eatingandbehavioralhealth.com

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Request an Appointment

Before requesting an appointment, please select whether you are a new patient or an existing patient.

Existing Patient

Request an Appointment (New Patient)

See therapists with immediate availability

If you do not have a specific clinician in mind or they are not available, please fill out the form below to be scheduled with a clinician who fits your needs.

I am scheduling for: *

Contact First Name *

Contact Last Name *

Email *

Phone Number *

Date of birth *

My insurance is: *

I am interested in scheduling with: *

Primary concern:

Check all that apply.

Eating / Body Image Concerns

PTSD / Trauma

Chronic Health

Anxiety

Depression

Other

What is your concern?

I am interested in:

Select one.

In-Person

Telehealth

Either

How did you hear about us?

Check all that apply.

Google

Psychology Today

Referral from other physician/provider

Other

Name of referring physician or provider:

Name of referring source, friend, family member, or other:

Please note: information sent via contact form is not secure, therefore exercise caution with any sensitive information. Do not use form for emergencies or highly confidential information.

Thank you for taking the first step in getting help. We will reach out to you in 24-48 hrs after receiving your request to start the scheduling process.

There was an error trying to send your message. Please try again later.

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