Application for The Reclaim Your Life From Food Programme

Please fill out the questionnaire below, giving as much information as possible. The aim is for me to assess if I can help you.

Thank you for completing this application.

    Q1: How often do you binge eat/eat compulsively/overeat?

    Q2: How long have you had a problem with food?

    Q3: What time of day do you eat the most?

    Q4: What have you tried up to this point to deal with this problem? How successful were these strategies?

    Q5: Tell me what triggered your last overeating episode (An argument? Stress? Boredom? Be as specific as possible)

    Q6: What sort of food did you eat on that occasion?

    Q7: How did you feel afterwards?

    Q8: How important is secrecy for you when you overeat?

    Q9: How well are you able to resist your cravings?
    I have a range of strategiesIt dependsI can sometimes resist cravingsI can never resist them - they overwhelm me

    Q10: What support do you have to help you with your eating and/or weight problems? (people, websites, books etc)

    Q11: What do you normally eat for breakfast?

    Q12: If you answered 'other', please describe what you normally eat for breakfast

    Q13: If you could magically make your eating problems disappear, how would your life improve? How would you be different?

    Q14: Is there any additional information you want to include?

    Please note I am away until 17th August 2020 and will reply to your application then. Many thanks for your patience.

    Your privacy is important to The Shift Inside. All information is completely confidential and stored securely. You can access the privacy policy here

    Thank you very much for completing this assessment. 

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