Address of GP surgery* SCOFF Questionnaire The SCOFF questionnaire is a five-question screening tool designed to clarify suspicion that an eating disorder might exist rather than to make a diagnosis. S Do you make yourself sick – Yes No N/A because you feel uncomfortably full? C Do you worry you have lost control – Yes No N/A over how much you eat? O Have you recently lost more than – one stone (6.35kg) in a three-month Yes No N/A period? F Do you believe yourself to be fat – Yes No N/A when others say you are too thin? F Would you say food dominates – Yes No N/A your life? Additional questions: Are you satisfied with your eating Yes No N/A patterns? Do you ever eat in secret? Yes No N/A Section 3: agencies involved Please tick if any of the following are working with / have worked with the child / young person / family Nursery / Pre-School Connexions Personal Adviser School Nurse / Home-school Link Youth Offending Team Learning Disabilities worker Nurse Social Worker Inclusion / Educational Welfare Learning Support Officer Health Visitor Education Psychologist Behaviour Support Services (Please state)
Address of GP surgery* SCOFF Questionnaire The SCOFF questionnaire is a five-question screening tool designed to clarify suspicion that an eating disorder might exist rather than to make a diagnosis. S – Do you make yourself sick because you feel uncomfortably full? Yes No N/A C – Do you worry you have lost control over how much you eat? Yes No N/A O – Have you recently lost more than one stone (6.35kg) in a three-month period? Yes No N/A F – Do you believe yourself to be fat when others say you are too thin? Yes No N/A F – Would you say food dominates your life? Yes No N/A Additional questions: Are you satisfied with your eating patterns? Yes No N/A Do you ever eat in secret? Yes No N/A Section 3: agencies involved Please tick if any of the following are working with / have worked with the child / young person / family Nursery / Pre-School Connexions Personal Adviser School Nurse / Learning Disabilities Nurse Home-school Link worker Youth Offending Team Social Worker Inclusion / Learning Support Educational Welfare Officer Health Visitor Education Psychologist Behaviour Support Services (Please state)