If you are concerned that you or someone you
know may be exhibiting traits associated with eating disorder, we encourage you
to take our brief, confidential online screening survey. Our simple process
involves only you providing us with a valid E-mail address which we may send
your results to, and you answering a series of seven questions as they appear.
We do not intend to use your email address for any other purpose. All
information provided via to The Bella Vita by any potential client or
associate, whether via electronic or written means, is always held to the
strictest policies of confidentiality.
E-Mail Address (REQUIRED)
1.) Within the past 6 months, have you had uncontrollable eating binges or
restrictive eating patterns?
2.) Within the past 6 months, have you used dieting, steroids, laxatives, drugs
(i.e., speed, cocaine, crystal meth), over the counter pills (i.e., muscle
builders, appetite suppressants, slimming tea) to influence your weight, body
shape or appearance?
3.) Within the past 6 months, have you induced vomiting to control your weight
or rid yourself of unwanted calories?
4.) Within the past 6 months, have you exercised in excess to lose weight or
build muscle due to being dissatisfied with your body shape?
5.) Within the past 6 months, have you participated in a sport or involved in a
profession that demands weight control restrictions?
6.) Within the past year, has your compulsive exercising, body dissatisfaction,
eating behaviors or decreased sexual drive negatively impacted a significant
relationship?
7.)Within the past year, have you had depression, anxiety, trauma,
obsessive-compulsive or psychological issues that have negatively impacted your
overall functioning?