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Weight Control Questionaire  

476 Cahaba Park Circle

Birmingham, AL 35242

(205)980-4470

 Full Name:  
Session Objective:  

INSTRUCTIONS:

Below are some statements that describe what some people get out of drinking alcohol (or other substance abuse).  How often to you feel this way when you are drinking alcohol?  By answering the statements below, you provide us a guide that will enable us to know the most effective way to rid you of the Weight_Control habit permanently.

Click the bubble under the response that best fits you.  The default answer is "always".
No.

QUESTION

Always Frequently Occasionally Seldom Never
1 I eat to perk myself up.
2 I get some enjoyment from preparing my food.
3 I find eating pleasurable.
4 Eating takes my mind off my cares and worries.
5 I really notice when I am not eating.
6 I find myself eating and do not remember getting the food.
7 Eating gives me a lift.
8 Handling my food is part of the enjoyment of eating.
9 I enjoy eating certain comfort foods.
10 When I feel upset, I eat something.
11 I find myself snacking when talking on the phone.
12 I get a craving for food when I haven't eaten for awhile.
13 I snack automatically without being aware of it.
14 I enjoy snacking while watching TV.
15 I grab a snack when I feel angry about something.
16 I think about eating as soon as I awaken.
17 When I am not eating, I find it almost unbearable.
18 I pick up a snack without realizing I already have one.
                   

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