Timberline Knolls Admissions Form

Thank you for your interest in our program. By filling out the form below you are allowing us to begin a streamlined admissions process designed to best serve you. This form is secure, and the content you submit will be kept confidential. Please note that by submitting this information, you are providing consent for someone from our admissions department to contact you.

If you are in a state of crisis or need immediate help for any reason, please pause filling out this form and call 911.








Treatment History

Please list all current and past treatment history below:


































































Other Disordered Eating Behaviors: