Eating Disorder Intake Assessment Template


Our Eating Disorder Intake Assessment Template is designed for psychologists that have a special interest in supporting clients presenting with eating difficulties. The intake questionnaire and may be used within the initial consultations with a client referred for treatment of an eating disorder. This particular template is designed to help psychologists in writing their clinical notes.

What are other useful resources?


Our team at PPSG highly recommend connecting all clients and families that present for treatment of eating disorder or poor body image to the Butterfly Foundation. The Butterfly Foundation support anyone in Australia concerned by eating disorders or body image issues, whether needing support for yourself or someone you care about.

What are the must know warning signs?


It is not always easy to tell if an individual is suffering from an eating disorder based simply on their appearance. Often clients may attend therapy for another presenting problem without flagging difficulties. To assist psychologists in screening for eating disorders, we have included some (not all!) of the warning signs that must be watch out for, including behavioural, physical and psychological warning signs.


What behavioural warning signs to look out for? 


  • Dieting behaviours, such as fasting, counting calories or avoiding food groups

  • Evidence of binge eating, such as hoarding food

  • Evidence of vomiting or laxative use

  • Excessive or obsessive exercise patterns

  • Changes in food preferences (e.g. refusing to eat certain ‘fatty’ or ‘bad’ foods, cutting out whole food groups such as meat or dairy, claiming to dislike foods previously enjoyed, a sudden concern with ‘healthy eating’, or replacing meals with fluids)

  • Rigid patterns around food

  • Avoidance of eating meals in a social setting

  • Lying about the type or amount of food eaten

  • Social withdrawal or avoidance of previously enjoyed activities


What physical warning signs to look out for?


  • Weight fluctuation

  • Sensitivity to the cold, even in warm temperatures

  • Changes in menstrual patterns

  • Damage to teeth from vomiting

  • Fainting



What psychological warning signs to look out for?


  • Preoccupation with food, body shape and weight

  • Extreme body dissatisfaction

  • Distorted body image

  • Heightened anxiety around mealtimes

  • Depression, anxiety or irritability

  • Low self-esteem

  • Rigid ‘black and white’ thinking when it comes to food, such as labelling food ‘good’ or ‘bad’

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