WNYCCCED
Project ECHO® Eating Disorders (ECHO® EDO)
Registration for TeleECHO
If you wish to receive email notifications of and participate in the WNYCCED Project ECHO® Eating Disorders sessions for the clinical management of patients with eating disorders and their families, please complete the registration information on this form and return it to the email below.

Email: wnyccced@urmc.rochester.edu

Mail: Western NY CCCED, School of Nursing, 601 Elmwood Ave Box SON, Rochester NY 14642
Yes, I wish to register for the WNYCCCED Project ECHO® EDO Clinics coordinated by the University of Rochester School of Nursing and available through a ZOOM platform.

* 1. Organization Name 

* 2. Name

* 3. Credentials (MD, NP, PHP, etc.)

* 4. Specialty

* 5. Title / Role
e.g. Social Worker, Physician, Psychotherapist, etc

* 6. Address

* 7. City / State / Zip Code

* 8. County

* 9. Phone

* 10. Login Phone
The phone number that you would use when logging into the echo sessions

* 11. Email

* 12. Your Website URL (If available)

Project ECHO® Eating Disorders Clinics are eligible for continuing education credits through the Center for Experiential Learning at the University of Rochester Medical Center.  Attendance is required to qualify for CME / CEU for a session.  Instructions to receive CME /CEU will be communicated each session.  Currently, CME / CEU is provided at no cost to Project ECHO® Eating Disorders TeleECHO participants. 
 

To learn more about our TeleECHO Clinics for Eating Disorders you may contact us: 

Email: wnyccced@urmc.rochester.edu                   Phone: 585-275-2936
WNYCCCED is funded in part by NYS Department of Health Division of Chronic Disease Prevention Project ECHO URSON Registration 09.29.3016
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