Please answer all of the following questions to the best of your knowledge. Extra space has been provided in many cases for you to give detailed accounts.
(focus on the child you are most concerned about if habits vary)
When you are finished with the questionnaire, click Submit at the bottom of the form. I will contact you soon after receiving this questionnaire.
Food for thought for parents… (No need to answer on paper…)
How do you remember meals as a kid? Were they pleasant? Stressful?
Do you think the way you were fed as a child is impacting your feeding now?
Are you currently dieting to lose weight?
Do you currently have, or have had behaviors that concern you about your own eating? (fasting, diet pills, vomiting, eating in a way that felt out of control)?
Thank you for your time! This gives me valuable information so we can make the most of our time together!