• Eating Disorder Physical Exam Findings Record Form

    Use this form to record physical examination findings relevant to eating disorder care during a clinical visit.

  • Patient and Visit Information

  • Date of Birth*
     - -
  • Date of Exam*
     - -

  • Anthropometrics and Vital Signs

  • Orthostatic symptoms present?*

  • General Physical Examination Findings

  • General Appearance*
  • Nutritional Status / Body Habitus*
  • Edema Present?*

  • Head, Mouth, and Dental Findings

  • Lips / oral mucosa appearance*
  • Dryness of mouth / xerostomia*
  • Dental erosion / caries*
  • Parotid gland enlargement*
  • Tongue findings

  • Skin, Hair, and Nail Findings

  • Skin temperature/color
  • Dryness/flaking
  • Lanugo present?
  • Bruising / petechiae / purpura
  • Hair thinning or loss
  • Nail changes
  • Wounds, scars, or self-injury marks noted?

  • Cardiovascular Findings

  • Heart Rate/Rhythm Assessment*
  • Murmur Present?*
  • Peripheral Pulses
  • Chest Pain, Palpitations, or Syncope Reported?

  • Gastrointestinal and Abdominal Findings

  • Abdominal Appearance
  • Bowel Sounds
  • Abdominal Tenderness
  • Abdominal Distension
  • GI Symptoms Reported

  • Neurological and Mental Status Observations

  • Mental status*
  • Gait / balance*
  • Muscle weakness*
  • Tremor*

  • Assessment Summary and Follow-Up

  • Urgent concerns identified?*
  • Referral needed?*
  • Next follow-up date or timeframe
     - -
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