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Eating Disorder Screening Form

Asks about current weight & height, weight history, and dieting & food preoccupation. Built for primary care and pediatric offices screening for disordered eating during routine visits.

Questions
13
Pages
2
Time
about 3 min

Includes

  • Consent agreement
  • Emergency contact
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Your practice

Eating Disorder Screening Form

Page 1 of 2 · Your information

Live preview. Tap through it like a patient.

Who it is for

  • Primary care and pediatric offices screening for disordered eating during routine visits
  • College and university health centers identifying students at risk for eating disorders
  • Sports medicine clinics evaluating athletes for female or male athlete triad
  • Outpatient psychiatry and therapy practices assessing eating disorder severity at intake

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What's inside

Before you publish: Clinical review required: this worksheet does not calculate scores, diagnose, or recommend treatment. Confirm the questions and response options against your approved assessment protocol before use.

Page 1 · Your information

  1. Patient NameText · Required
  2. Date of BirthDate
  3. Current Weight & HeightText
  4. Weight HistoryLong Text
  5. Dieting & Food PreoccupationLong Text

Page 2 · Additional details

  1. Exercise PatternsLong Text
  2. Body Image AssessmentLong Text
  3. Dietary Patterns & RestrictionsLong Text
  4. Screening Score & Risk LevelLong Text
  5. Emergency ContactEmergency Contact

From form to a ready patient

  1. The Formisoft form builder with editable questions and required toggles

    01

    Make it yours

    Reword, reorder, or add to the Eating Disorder Screening Form, and add your logo.

  2. A patient filling out a Formisoft form on a phone

    02

    Patients finish it at home

    A secure link by text or email, filled out on their phone before the visit. No app.

  3. The Formisoft dashboard showing how many of today's patients are ready

    03

    Your team sees who is ready

    Each visit shows as ready once its forms are in. Answers land on the patient record.

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Questions

Responses are encrypted, only your team can see them, and a BAA is included.

Yes. You can add, remove, reorder, or reword any of the 13 fields. You can also add conditional logic, new pages, file uploads, e-signatures, and payment fields.

Yes. Attach the form to a visit type and every patient who books gets it right away, with a reminder before the visit if it is not done. Your calendar shows which visits are ready.

Send it before the visit, so patients arrive ready.

Book a short call and we will set up the Eating Disorder Screening Form for your practice, ready to send before the next visit.

BAA included · We set up your front desk

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