Get Ed Intake Assessment Questionnaire

The ED Intake Assessment Questionnaire is a crucial tool designed to gather information about users’ eating disorders and associated histories. Completing this form accurately online ensures the best possible care for individuals seeking support.

Follow the steps to complete the questionnaire effectively.

1. Press the ‘Get Form’ button to access the questionnaire and open it in your preferred editor.
2. Begin by filling in your personal information: include your full name (last, first, middle), address, age, sex, date of birth, place and country of birth, and year of arrival in Australia if applicable.
3. Provide your telephone numbers, and indicate whether it is acceptable for the team to call you at these numbers and leave messages for you.
4. Input your email address and Medicare number for reference. Write the name, relationship, and contact number of your emergency contact.
5. Document the name and address of your general practitioner (GP), noting the standard procedure of keeping your GP informed about your treatment.
6. Clarify your availability for appointments by circling the appropriate times across the given days.
7. Record your education history, including the number of completed years of schooling and relevant educational qualifications.
8. Specify your current and past occupations, and note any Centrelink benefits received.
9. In the section for describing your presenting problem, articulate the nature of your complaints and estimate the severity of your issues on the provided scale.
10. Detail your history of eating problems by indicating the age at which these behaviors started and what else was occurring at that time.
11. Provide your current weight, height, and historical weight information, including your lowest and highest weights.
12. Complete the psychiatric history by identifying any diagnosed conditions, past treatments, and hospitalizations.
13. List significant medical histories, medications, and whether they were helpful.
14. If applicable, fill in the substance use section, answering questions about alcohol and drug use.
15. Fill in your personal and social history, including details about your family background and relationships.
16. Review all information provided and when complete, save your changes, and consider options to download, print, or share the form.

Complete the ED Intake Assessment Questionnaire online to ensure you receive the support you need.