The Quick Admit Form
Quick Admit is designed to expedite the referral and admission process by providing the opportunity to complete required documentation online. The admissions process at Eating Recovery Center is designed with referring professionals in mind; your input is critical to ensure a holistic picture of your patient’s medical, psychological and social status. 

Please complete the form within MyERC to provide information to our Clinical Assessment team. By submitting this information, you are consenting to have a clinical team member follow up with you and to have our business office check insurance benefits.

The form includes patient, treatment team and assessment information, with the majority of fields as optional or “if applicable.” Have the following information on hand as you begin the online form, and complete the fields to the extent that you are able.

Patient Information
•    Patient name and contact information
•    Race, relationship status, disabilities, religion/spiritual orientation,
•    Advance directives, guardian information
•    Occupational history, education history, military service history

Insurance Information
•    Insurance company, contact information
•    Insured party/policy holder, policy holder date of birth
•    ID number, account number
•    Employer
•    Group number, Rx group number

Outpatient Treatment Team 
Provider name and contact information
•    Therapist
•    Dietitian
•    Psychiatrist
•    primary care physician

•    Height, weight
•    Diagnosis of eating disorder, mood/anxiety, substance abuse
•    Treatment history with facility name, dates of stay, level of care, outcome
•    Medical issues, current medications
•    Documented allergies to food, allergies to medications
•    Patient strengths
•    Preliminary treatment goals

Our Clinical Assessment Team is available to answer any of your questions about the referral process, treatment programs and aftercare planning. Additionally, we invite you to review our Frequently Asked Questions (need to add link) regarding Eating Recovery Center’s admissions process, insurance contracts and our commitment to engaging referring professionals in the treatment of their patients
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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.

Joint Commission Seal
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