Eating Habits Survey | QuestionPro

Age:

Gender:

Weight:

Height:

Ethnicity:

Have you ever been diagnosed/self-diagnosed with an eating disorder?

Yes

No

If yes, please specify which one:

If yes, please specify what age you were diagnosed:

Do you have a family history of addiction?

Yes

No

Are you obsessed or preoccupied with what you are eating?

Yes

No