This form can be used as a tool to assess your eating, weight, and shape concerns and/or as part of your eligibility for an Eating Disorder Management Plan.
Please note, this form will not be treated as an initial inquiry or referral to Centre for Integrative Health. If you are seeking support for eating or weight concerns for yourself or someone else, please contact our client care team on (07) 3161 0845 or firstname.lastname@example.org.
The following questions are concerned with the past four weeks (28 days) only
For the following questions, please select the appropriate number. Please note that for these questions the term “binge eating” means eating what others would regard as an unusually large amount of food for the circumstances, accompanied by a sense of having lost control over eating.
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