Self-assessment Form | Eating Recovery Center

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Call and speak to one of our experienced professionals for more information about:

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1-877-825-8584

The Basics

Relationship to patient

Your Information

Tell us about yourself:

First Name

Last Name

First Name

Last Name

Phone

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Yes

State

Type of Insurance

Program of Interest

Relationship to Policyholder

Condition

Please be advised that treatment coverage under Medicaid requires a Single Case Agreement (SCA). This is a special contract negotiated between ERC Pathlight and Medicaid for your specific treatment. While ERC Pathlight initiates this process on behalf of the patient, approval is determined by Medicaid.

We do not currently accept government insurance plans (Medicare, Medicaid, VA) as a primary insurance in your state. Please contact your insurance company for assistance with seeking care at an in-network facility. Explore additional treatment options and resources that may be right for you on our insurance page.

Date of Birth

Enter date in MM/DD/YYYY format.

By entering in your telephone number, you agree to receive transactional SMS notifications and reminders from ERC and Pathlight via short code 73821. Message and data rates may apply. Message frequency may vary. You may receive alerts until you choose to opt out of this service by texting STOP to 73821 or replying STOP to any of our messages. Text HELP to 73821 for assistance.

Patient Information

Patient's First Name

Patient's Last Name

Patient Date of Birth

Enter date in MM/DD/YYYY format.

Eating Recovery Center is accredited through the Joint Commission. This organization seeks to enhance the lives of the persons served in healthcare settings through a consultative accreditation process emphasizing quality, value and optimal outcomes of services.

Organizations that earn the Gold Seal of Approval™ have met or exceeded The Joint Commission’s rigorous performance standards to obtain this distinctive and internationally recognized accreditation. Learn more about this accreditation here.