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 induced vomiting to control your weight?
3.) Within the past year, have you been significantly dissatisfied with your
body?
4.) Within the past year, have your food, weight and appearance issues
negatively impacted a significant relationship?
5.) Within in the past 6 months, have you used laxatives, diet pills, drugs
(i.e., speed, cocaine, crystal meth) or water pills to influence your weight,
shape or appearance?
6.) Within the past 6 months, have you over exercised to increase burning of
calories to influence your weight, shape or appearance?
7 .) Within the past year, have you had depression, anxiety,
trauma, obsessive-compulsive or psychological issues that have negatively
impacted your overall functioning in life?