1. Default Section

Name (OPTIONAL):

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* 1. Name (OPTIONAL):

Gender:

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* 2. Gender:

Age:

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* 3. Age:

Type of Eating Disorder:

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* 4. Type of Eating Disorder:

Which insurance company do you have? Or are you uninsured?

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* 5. Which insurance company do you have? Or are you uninsured?

Have you ever had difficulties finding treatment or resources for your eating disorder or body image issues?

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* 6. Have you ever had difficulties finding treatment or resources for your eating disorder or body image issues?

How did you hear about EDRC and our free support groups?

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* 7. How did you hear about EDRC and our free support groups?

At what location did you attend this support group?

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* 8. At what location did you attend this support group?

Who was the facilitator of the support group you attended?

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* 9. Who was the facilitator of the support group you attended?

Number of meetings attended:

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* 10. Number of meetings attended:

Please mark one answer for each question below:

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* 11. Please mark one answer for each question below:

  Excellent Good Average Poor
Location
Day of the meeting (1st and 3rd Wednesday)
Day of the meeting (Thursday)
Day of the meeting (1st and 3rd Saturday)
Time of the meeting (Wednesday)
Time of the meeting (Sunday)
Length of the meeting
Size of the group
Group leader skills
The support group overall
List 2 ways this support group has been beneficial to you.

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* 12. List 2 ways this support group has been beneficial to you.

I feel more empowered to stand up to my eating disorder.

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* 13. I feel more empowered to stand up to my eating disorder.

I feel more confident and comfortable with my body.

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* 14. I feel more confident and comfortable with my body.

I have learned useful skills and tools to help with my recovery from my eating disorder or body image conerns.

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* 15. I have learned useful skills and tools to help with my recovery from my eating disorder or body image conerns.

I feel more connected to others who are struggling with the same issues and can help support me in my recovery.

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* 16. I feel more connected to others who are struggling with the same issues and can help support me in my recovery.

I have gained information that I found useful to better manage my treatment for my eating disorder/body image issues.

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* 17. I have gained information that I found useful to better manage my treatment for my eating disorder/body image issues.

How helpful has this support group been:

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* 18. How helpful has this support group been:

How could the group be improved?

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* 19. How could the group be improved?

Would you come to another EDRC support group meeting again?

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* 20. Would you come to another EDRC support group meeting again?

If no, is there anything that would affect your decision to return to the support group?

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* 21. If no, is there anything that would affect your decision to return to the support group?

Would you recommend this support group to other people?

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* 22. Would you recommend this support group to other people?

Are there any other topics or formats that you would like to see implemented or learn more about?

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* 23. Are there any other topics or formats that you would like to see implemented or learn more about?

Other comments or suggestions?

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* 24. Other comments or suggestions?

Please provide your name and home mailing address if you would like to be on our mailing list.

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* 25. Please provide your name and home mailing address if you would like to be on our mailing list.

Please list your email address if you would like to get email reminders and updates about the support group location you attended.

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* 26. Please list your email address if you would like to get email reminders and updates about the support group location you attended.

Would you like to get updates/reminders for ALL the EDRC support groups?

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* 27. Would you like to get updates/reminders for ALL the EDRC support groups?

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