Meal Support Program with Clinician's Incubator

Through Project HEAL's partnership with Clinician's Incubator, you may apply for free, weekly, virtual, meal support. Meal support sessions are live, facilitated, virtual group meals creating a safe space for those at the outpatient stage of eating disorder recovery to consume nutrition with extra support. 

Meal support times happen four times daily (two "lunch" times and two "dinner" times). Once approved, you can attend as many meal support times as makes sense in your schedule. 

Following your submission of this intake form, you will be contacted by the Clinician's Incubator team for information on next steps.

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Date of Birth: *
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Phone Number:  *
Mailing Address: *
Please select the option/s below that best reflect your racial identity: *
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Please select the option/s below that best reflect your sexual orientation:
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Do you identify as disabled and or/neurodivergent? Check all that apply: *
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Are you currently seeing a therapist? *
If applicable, please provide the name of your therapist:
Are you currently seeing a nutrition provider? *
If applicable, please provide the name of your nutrition provider:

Have you ever attended an eating disorder treatment center for a higher level of care (Inpatient, Residential, PHP, IOP)?
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If applicable, please list all of your past treatment stays including month/year, level of care, and location:
Have you previously participated in meal support?  *
If applicable, please list all of the meal support programs you have been a part of: 
What is your purpose in seeking meal support at this time?  *
Emergency Contact Name: *
Emergency Contact Phone Number: *
Emergency Contact Email: *
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