Eating Attitudes Test (EAT-26)

Instructions: This is a screening measure to help determine whether you might have an eating disorder that needs professional attention. This screening measure is not designed to make a diagnosis of an eating disorder or take the place of a professional consultation. Please fill out the form below as accurately, honestly, and completely as possible. There are no right or wrong answers. All of your responses are confidential.

Part A: Complete the following:

Part B: Please choose one response for each of the following statements:

Part C: Behavioral Questions. In the past 6 months have you:

Below is a list of common symptoms of anxiety. Please carefully read each item in the list. Indicate how much you have been bothered by that symptom during the past month, including today, by making one choice for each symptom by marking the corresponding box in the column.

Instructions: This questionnaire consists of 21 groups of statements. Please read each group of statements carefully, and then pick out the ONE statement in each group that best describes the way you have been feeling during the past two weeks, including today. If several statements in the group seem to apply equally well, choose the farthest down on the list that applies. Be sure that you do not choose more than one statement for any group, including Item 16 (Changes in Sleeping Pattern) or Item 18 (Changes in Appetite).

Please read each statement and choose which number (0, 1, 2, or 3) indicates how much the statement applied to you over the past week. There are no right or wrong answers. Do not spend too much time on any statement.

The rating scale is as follows:

0   Did not apply to me at all

1   Applied to me to some degree, or some of the time

2   Applied to me to a considerable degree or a good part of the time

3   Applied to me very much or most of the time

AUDIT

The Alcohol Use Disorders Identification Test: Self-Report Version

PATIENT: because alcohol can affect your health and can interfere with certain medications and treatments, it is important that we ask some questions about your use of alcohol. Your answers will remain confidential so please be honest. Please choose the item that best describes your answer to each question.

Instructions: Below are groups of numbered statements. Read all of the statements in each group and choose the statement that BEST describes the way you feel about how you control your eating behavior. Note: some questions may only have 3 choices.

The following questions concern information about your possible involvement with drugs not including alcoholic beverages during the past 12 months. Carefully read each statement and decide if your answer is "Yes" or "No". Then, choose the appropriate response beside the question.

In the statements "drug abuse" refers to (1) the use of prescribed or over the counter drugs, which may include: cannabis (e.g. marijuana, hash), solvents, tranquilizers (e.g. Valium), barbiturates, cocaine, stimulants (e.g. speed), hallucinogens (e.g. LSD), or narcotics (e.g. heroin). Remember that the questions do not include alocholic beverages.

Please answer every question. If you have difficulty with a statement, then choose the response that is mostly right.