Name *

First Name

Last Name

1. *

I consider certain foods, like chips or dessert, "Bad," and foods like spinach and oranges "Good."

True

False

2. *

There are certain foods I believe "I can never have" like ice cream, pizza, and potato chips.

True

False

3. *

If I overeat or eat "bad" foods, then I beat myself up for not honoring my diet.

True

False

4. *

I believe it's normal to eat to celebrate.

True

False

5. *

I believe food is one of the most important pleasures of life.

True

False

6. *

I believe cutting back on foods is painful.

True

False

7. *

I believe I should be able to eat anything I want.

True

False

8. *

I believe the weekend is time to enjoy foods I don't allow myself during the week.

True

False