Eating Disorder Risk Assessment Form
Full Name
Age
Gender
Female
Male
Non-binary
Other
Prefer not to say
Email Address
Have you recently experienced significant weight loss or gain?
Yes
No
Do you often feel dissatisfied with your body or weight?
Yes
No
Do you engage in restrictive dieting or skip meals frequently?
Yes
No
Have you experienced episodes of eating large amounts of food in a short period?
Yes
No
Do you use methods to compensate for eating (e.g., vomiting, excessive exercise, laxatives)?
Yes
No
Other concerns or comments