Period everyenter number days.
Over the last 2 weeks, how often have you been bothered by any of the following problems?
The following questions ask about your eating pattern and behaviors within the last 3 months. For each question, choose the answer that best applies to you.
Please answer the questions below, rating yourself on each of the criteria shown using the scale on the right side of the page. As you answer each question, place an X in the box that best describes how you have felt and conducted yourself over the past 6 months. Please give this completed checklist to your healthcare professional to discuss during today’s appointment.