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* 1. Please enter your contact info:

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* 2. Today's Date:

Date

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* 3. How often do you have eating disorder behaviors?

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* 5. Currently, what benefits of feeling gratitude do you experience? Check all that apply:

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* 6. What gratitude practice(s) do you have? Check all that apply:

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* 7. How can a regular gratitude practice impact your life?

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* 8. What best describes your attitude about gratitude?

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* 9. What is your current awareness of things to feel grateful about?

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