Eating disorders affect millions of people worldwide and early detection is critical for effective treatment and recovery. This eating disorder screening form provides healthcare providers, counselors, and wellness professionals with a comprehensive assessment tool that combines validated screening instruments with practical questions about nutrition and body image concerns.
This template incorporates the widely-used Eating Attitudes Test (EAT-26) questions along with body image assessment items and nutritional risk factors. The form helps identify warning signs across the spectrum of eating disorders, including anorexia nervosa, bulimia nervosa, binge eating disorder, and other specified feeding or eating disorders (OSFED).
The screening covers critical areas including:
Whether you're a therapist, dietitian, primary care physician, school counselor, or wellness coach, this form helps you gather essential information before an initial consultation. The pre-visit format saves valuable appointment time and allows you to review responses beforehand to better prepare for the conversation.
Paperform makes it easy to collect sensitive health information securely while maintaining a supportive, non-judgmental tone. Customize the questions to match your practice needs, add your branding, and embed the form directly on your website or send via a private link.
Connect this screening form to your existing workflows using Stepper, Paperform's AI-native workflow builder. Automatically route high-risk responses to urgent follow-up lists, send personalized resource emails based on screening scores, update your EHR system, and schedule follow-up appointments—all without manual data entry.
For practices requiring signed consent or treatment agreements following screening, Papersign seamlessly converts form responses into professional documents ready for eSignature, keeping everything connected and compliant.
Paperform is SOC 2 Type II compliant and provides secure data handling for sensitive health information, though please note it is not HIPAA compliant. This template helps you deliver compassionate, evidence-based care while reducing administrative burden and ensuring no one falls through the cracks.
A comprehensive eating disorder screening form that assesses eating behaviors, body image, nutritional status, and mental health to identify individuals who may benefit from professional support and referral.
Track sobriety milestones, identify relapse triggers, and monitor support group attendance for addiction recovery programs. A comprehensive check-in form for patients and counselors.
A confidential, trauma-informed screening tool for healthcare providers to assess intimate partner violence risk, conduct safety planning, and connect patients with appropriate resources and support services.
A professional registration form designed for maternal mental health conferences, workshops, and training events. Capture provider credentials, specialization areas, and training interests to deliver a tailored conference experience.
A comprehensive intake form for memory clinics to assess cognitive decline, screen for dementia, evaluate caregiver burden, and identify safety concerns for new patients.
A confidential mental health screening tool featuring the PHQ-9 depression scale and GAD-7 anxiety assessment, with personalized resource recommendations based on your responses.
A comprehensive pre-visit assessment form to screen for panic disorder, track panic attack frequency, evaluate physical symptoms, and assess for agoraphobia.
A comprehensive screening form to assess seasonal affective disorder symptoms, evaluate light exposure, track mood patterns, and provide personalized light therapy recommendations.
Confidential substance abuse screening tool featuring the CAGE questionnaire, drug use history assessment, mental health evaluation, and treatment resource connections.
A confidential pre-visit substance use screening form featuring the CAGE questionnaire, readiness to change assessment, and detox safety evaluation for addiction medicine providers.
A comprehensive autism screening tool for toddlers aged 16-30 months using the Modified Checklist for Autism in Toddlers, Revised (M-CHAT-R), with developmental milestones assessment and specialist referral support.
A comprehensive pre-visit symptom assessment form for tracking autoimmune disease symptoms, identifying flare patterns, and monitoring medication side effects across multiple organ systems.