Eating Disorder Survey

Would you (or a loved one) agree that food is the most important aspect of your life?*

YesNo

When people say you're too slim, do you (or a loved one) believe you're fat?*

YesNo

Do you (or a loved one) worry that you've lost control of your eating habits?*

YesNo

Do you (or a loved one) make themselves sick because you're overly full?*

YesNo

Have you (or a loved one) dropped more than 14 pounds in the last three months?*

YesNo

We need to reach you to discuss your answers and try to find a solution to make you feel better.

That's why, please share your name and email address with us🤙🏻

Name*

First NameLast Name

Email*

example@example.com