Internet Addiction and Eating Disorders Survey
Help us understand the relationship between internet usage and eating behaviors by answering the following questions. Your responses are confidential and anonymous.
Full Name
First Name
Last Name
What is your age?
*
Gender
*
Male
Female
Non-binary
Prefer not to say
Other
On average, how many hours per day do you spend online (excluding work or school)?
*
Please Select
Less than 1 hour
1-3 hours
4-6 hours
7-9 hours
10+ hours
In the past month, how often have you experienced the following?
*
Rows
Never
Rarely
Sometimes
Often
Very Often
Eating more than intended while using the internet
1
2
3
4
5
Skipping meals due to internet use
6
7
8
9
10
Feeling anxious or irritable when unable to access the internet
11
12
13
14
15
Using the internet to cope with negative emotions
16
17
18
19
20
Have you ever been diagnosed with an eating disorder by a healthcare professional?
*
Yes
No
Prefer not to say
Please share any additional comments or experiences related to internet use and eating habits (optional):
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