Alsana's Eating Disorder Assessment Survey | Free and Confidential

Alsana's FREE, confidential eating disorder assessment survey

Eating disorders impact people of all genders and body types. If you or a loved one are struggling, this survey can help determine if treatment may be right for you.

Step 1 of 15

Do you make yourself sick because you feel uncomfortably full?

Do you attempt to restrict calories or foods ?

Do you struggle with thoughts of killing yourself?

Do you struggle with self harm behaviors?

Do you consume alcohol?

Do you use recreational drugs including cannabis products?

Have you experienced trauma in the past that has contributed to behaviors or thoughts about food and your body?

Do you have any medical complications related to your eating disorder?

Have you ever had abnormal lab work?

Are you currently working with an outpatient therapist or provider?

Have you ever gone to the emergency room or been hospitalized for your eating disorder?

Are you having any issues in the following areas?

What are your treatment plans?

Optional

What’s prompting you to seek treatment at this time?

Optional

What kind of stressors have you had recently that you think may be making symptoms/behaviors worse? What behaviors have increased in the last 2 weeks?

Call 911 immediately

If you or someone you know is having a psychiatric emergency or a suicide attempt is likely, please CALL 911 IMMEDIATELY.