Demographic Information
Fields marked with an * are required

Any data collected will be used to evaluate and amend this website.

For more information, please ensure you read our information sheet.



We would like to ask some brief questions about you and your loved one who has an eating disorder. This is to help us determine who is using the website.

If complete this form, your details will be used to support the evaluation of this resource. You can read more about this here, on the  information sheet.

Are you viewing the site as a: *
What is your gender? *
What is your age? *
What is your marital status? *
Where are you currently living? *
What is your relationship to the young person you are caring for? *
Do you currently live with this young person? *
Has the young person you are living with been diagnosed with an eating disorder? *
If yes, what is their diagnosis?
If no, what illness do they identify with, if any?
Where did you hear about this resource? *