PRACTITIONER/TREATMENT LOG

Part of your personal ‘journey’ when seeking support for your illness may involve different practitioners over a period of time.

This document allows you to record details of the practitioners you are seeing, what they are called and the role that they adopt.

Provision is made for updating information with a series of blank sheets.

Date Issued:
Name:
Address:
Town/City: / Postcode:
Telephone No:
Mobile No:
E-mail address:

By simply copying a blank sheet prior to completing you can add additional pages to this log as required

SEED Eating Disorder Support Services Admin (01482) 344084 Helpline (01482) 18130 Charity No 1108405

PRACTITIONER/TREATMENT LOG

Date / Organisation/Department / Named Person / Role of Named Person / Contact Details / Notes
Date / Organisation/Department / Named Person / Role of Named Person / Contact Details / Notes
Date / Organisation/Department / Named Person / Role of Named Person / Contact Details / Notes
Date / Organisation/Department / Named Person / Role of Named Person / Contact Details / Notes
Date / Organisation/Department / Named Person / Role of Named Person / Contact Details / Notes

PRACTITIONER/TREATMENT LOG

Date / Organisation/Department / Named Person / Role of Named Person / Contact Details / Notes
Date / Organisation/Department / Named Person / Role of Named Person / Contact Details / Notes
Date / Organisation/Department / Named Person / Role of Named Person / Contact Details / Notes
Date / Organisation/Department / Named Person / Role of Named Person / Contact Details / Notes
Date / Organisation/Department / Named Person / Role of Named Person / Contact Details / Notes

PRACTITIONER/TREATMENT LOG

Date / Organisation/Department / Named Person / Role of Named Person / Contact Details / Notes
Date / Organisation/Department / Named Person / Role of Named Person / Contact Details / Notes
Date / Organisation/Department / Named Person / Role of Named Person / Contact Details / Notes
Date / Organisation/Department / Named Person / Role of Named Person / Contact Details / Notes
Date / Organisation/Department / Named Person / Role of Named Person / Contact Details / Notes