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Pre-Consultation Intake Questionnaire

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Food and Eating Habits Assessment

Do you experience feelings of guilt or regret after eating?
Have you experienced periods where you restrict your food intake, either intentionally or unintentionally?
Do you experience episodes of binge eating or overeating?

Exercise Habits Assessments

Do you feel guilty or anxious if you miss a workout?
Do you ever exercise to "make up" for eating certain foods?
Would you like support in setting realistic, achievable fitness goals?

Body Image

Does thinking about your body take up a lot of your mental energy?
Do you feel your body image affects your mood or self-esteem?
Do you believe you must change your body to feel confident or accepted?

Alcohol Habits Assessment

Do you find it difficult to stop drinking once you’ve started?
Would you like support or guidance in reducing your alcohol intake?
Do you have a tendency to binge eat or overeat after drinking?