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ARFID Questionnaire

​Test for Avoidant/Restrictive Food Intake Disorder

 

Please complete the following questionnaire and we will contact you to discuss your responses:

Do you consume a limited food variety?
Yes
No
Do you often gag when eating certain foods?
Yes
No
Do you go through phases of eating the same food repeatedly and exclusively for a while, to then get tired of it and stop eating it all together?
Yes
No
Is mealtime stressful because of foods that are presented at the table?
Yes
No
Do you struggle with eating certain foods because of their texture?
Yes
No
Do you feel anxious about trying foods that you haven’t had before because you worry you may not like them?
Yes
No
Do you avoid social settings where food is present for fear there may not be something there you like to eat?
Yes
No
Would you rather go hungry than eat food you don't like?
Yes
No
Do you avoid eating foods if you don't like how they look?
Yes
No
Do you lose interest in food eating generally?
Yes
No
Do friends and family call you a “picky eater”?
Yes
No
Do you only eat a particular brand of certain foods?
Yes
No
Please confirm that you agree for us to contact you:
I agree

We will contact you using the email address you have provided above (please check your Junk/Spam folder for an email from enquiries@Flourishtherapyclinic.co.uk).

If you prefer us to ring you, please provide your phone Number

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